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Louisiana 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
$968.33 / $1,027.92 / $1,384.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.00 / $1,027.92 / $1,117.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,559.46 / $2,664.10 / $3,744.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,063.51 / $1,272.08 / $1,272.08
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $1,037.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.10 / $850.58 / $1,313.43