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North Dakota 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
$1,219.74 / $1,219.74 / $1,219.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.99 / $996.99 / $1,234.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,567.54 / $1,853.39 / $1,899.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.13 / $2,079.71 / $2,615.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,219.74 / $1,341.22 / $8,839.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.91 / $966.17 / $1,734.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.10 / $836.39 / $1,970.15