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Florida 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
$749.00 / $830.05 / $950.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.46 / $927.14 / $1,582.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,175.06 / $1,175.06 / $1,292.51
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 / $1,105.76
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.99 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.32 / $1,357.20 / $1,807.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,446.22 / $1,446.22 / $1,446.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.16 / $893.83 / $1,246.24
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.88 / $1,124.88 / $1,807.78