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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
$842.83 / $842.83 / $842.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.83 / $903.07 / $1,086.14
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,725.88 / $5,151.75 / $10,513.18
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.06 / $1,463.94 / $1,883.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,036.29 / $2,489.33 / $3,193.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,419.23 / $1,487.09 / $1,487.09
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 / $2,059.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,573.00 / $1,573.00 / $1,651.65
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,252.25 / $1,371.71 / $1,371.71
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,605.58 / $10,513.18 / $10,513.18
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.57 / $962.35 / $1,883.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.88 / $985.07 / $1,883.78