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Missouri 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

Facilitymedian $1,445 · 10th–90th $912$3,6310%20%10th90th$1,445Professionalmedian $977 · 10th–90th $794$1,6600%20%40%10th90th$977$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $933.25 / $1,621.81
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,122.02 / $1,621.81
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,778.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,445.44 / $3,890.45
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $851.14 / $10,715.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $1,412.54 / $1,412.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $851.14 / $1,348.96