go back

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $954.99 / $2,089.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,288.25 / $1,348.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,122.02 / $1,659.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,778.28
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 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,445.44 / $3,890.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $10,715.19
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,380.38 / $1,778.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $851.14 / $1,318.26