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Illinois 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
$912.91 / $912.91 / $912.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.71 / $912.91 / $1,083.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.11 / $1,332.11 / $1,332.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.51 / $8,552.43 / $18,653.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,153.46 / $1,349.87 / $1,349.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,898.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $2,059.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,598.54 / $2,176.61 / $2,693.99
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,309.00 / $2,309.00 / $2,309.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.68 / $1,432.41 / $1,504.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.23 / $886.10 / $1,521.15