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Idaho 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
Professional
Modifier
Low / Median / High Price
$872.12 / $1,468.02 / $1,575.24
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 / $1,037.25 / $1,105.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,215.80 / $1,521.31 / $1,798.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,619.07 / $1,709.02 / $1,798.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,327.63 / $1,581.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.24 / $1,756.81 / $2,635.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,259.28 / $1,259.28 / $1,888.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.69 / $828.14 / $1,350.60