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Kansas 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
$1,428.84 / $1,428.84 / $1,428.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.43 / $936.14 / $1,428.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,294.11 / $1,294.11 / $1,294.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,293.27 / $1,361.34 / $1,448.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,429.41 / $1,429.41 / $1,429.41
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 / $2,573.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$936.14 / $1,390.59 / $8,839.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.10 / $860.83 / $2,202.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.80 / $860.83 / $1,212.33