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Minnesota 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
Facility
Modifier
Low / Median / High Price
$1,234.11 / $1,234.11 / $1,234.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.05 / $996.99 / $1,234.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,521.51 / $1,776.15 / $2,473.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.92 / $1,687.34 / $1,776.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $5,480.01 / $15,220.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.13 / $2,182.67 / $2,615.09
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,253.42 / $5,257.80 / $11,984.46
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.13 / $2,059.13 / $2,118.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,215.80 / $1,776.15 / $8,839.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.10 / $919.40 / $1,892.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.10 / $836.39 / $1,785.74