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California rates for HCPCS L4631

Ankle-foot orthosis (AFO), walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.99 / $996.99 / $6,385.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.83 / $996.99 / $1,461.79
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,505.04 / $1,505.04 / $2,124.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.77 / $3,392.99 / $7,025.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.08 / $1,124.88 / $1,651.82
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $2,620.36 / $4,679.21
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $2,936.68 / $6,840.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,980.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $757.19 / $1,105.76
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,329.32 / $1,595.18 / $2,434.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.98 / $1,549.31 / $3,364.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,240.43 / $8,839.16 / $10,513.18
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,623.84 / $10,644.35 / $15,885.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,672.92 / $3,672.92 / $3,672.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,956.76 / $2,213.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $1,720.67
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,177.52 / $4,177.52 / $4,177.52
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,329.32 / $1,770.64 / $1,991.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.69 / $828.14 / $2,213.30