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Montana 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 $1,622 · 10th–90th $1,175–$2,0890%20%40%10th90th$1,622Professionalmedian $1,072 · 10th–90th $759–$1,7780%10%10th90th$1,072$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,000.00 / $1,584.89
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,778.28 / $1,778.28
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,621.81 / $3,162.28
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,621.81 / $3,162.28
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,698.24 / $2,238.72
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,318.26 / $1,778.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $1,047.13 / $1,071.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $831.76 / $1,318.26