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Maine rates for HCPCS L4631

Ankle Foot Orthosis 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
Professional
Modifier
Low / Median / High Price
$842.83 / $1,170.85 / $1,170.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,715.64 / $2,222.78 / $4,120.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.95 / $1,041.95 / $1,124.88
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 / $757.19 / $1,037.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,573.00 / $1,573.00 / $1,573.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.99 / $1,170.85 / $1,170.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.57 / $985.07 / $2,213.11