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Colorado 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
$938.85 / $938.85 / $938.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$858.50 / $938.85 / $1,349.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,676.52 / $1,883.74 / $3,420.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.88 / $1,124.88 / $1,214.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,037.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $757.19 / $1,846.33
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.85 / $1,215.80 / $2,339.35
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,215.80 / $1,215.80 / $1,215.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,223.85 / $2,095.65 / $3,319.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.69 / $828.14 / $1,246.24