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Nebraska 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
$1,100.36 / $1,100.36 / $1,100.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.99 / $1,100.36 / $1,215.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,516.55 / $1,668.20 / $1,685.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,898.04 / $1,898.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,037.25 / $1,898.04 / $2,926.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,100.36 / $1,888.70 / $8,839.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.08 / $860.83 / $1,434.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,892.49 / $1,898.04 / $2,521.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,554.49 / $2,274.82 / $3,910.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.08 / $860.83 / $1,246.24