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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
$937.55 / $937.55 / $937.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.49 / $921.77 / $937.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,494.97 / $1,928.99 / $2,206.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.95 / $1,124.88 / $1,124.88
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 / $1,037.25
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,253.83 / $1,253.83 / $1,253.83
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.83 / $1,350.29 / $1,928.99
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,371.71 / $1,371.71 / $2,528.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.42 / $962.35 / $1,799.32