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Massachusetts 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
$851.14 / $851.14 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $912.01 / $1,621.81
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,905.46 / $10,471.29
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,479.11 / $1,995.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,511.89 / $3,311.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,479.11 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,071.52
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,570.40
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,380.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,905.46 / $10,471.29
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,479.11 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1,047.13 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,148.15 / $1,698.24