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New Mexico 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
$878.56 / $878.56 / $878.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.56 / $996.99 / $6,385.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,597.92 / $8,806.44 / $15,590.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.43 / $1,431.24 / $1,705.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,037.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $1,037.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.33 / $1,791.67 / $2,687.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,215.80 / $1,215.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $2,099.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.69 / $828.14 / $1,246.24