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Connecticut 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
$933.25 / $933.25 / $933.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $933.25 / $1,412.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,949.84 / $2,344.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,122.02 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,412.54 / $2,041.74
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,511.89 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $1,445.44