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Ohio 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 $1,905 · 10th–90th $955$3,0900%20%40%10th90th$1,905Professionalmedian $955 · 10th–90th $776$1,5850%20%40%10th90th$955$2.0$10.0$50.0$200.0$1.0K$5.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $1,348.96 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $933.25 / $1,230.27
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $1,905.46 / $3,890.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,071.52 / $2,344.23
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,513.56
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $1,548.82 / $2,187.76
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,621.81 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,047.13
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,230.27 / $1,778.28
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,187.76 / $2,187.76
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,041.74 / $3,715.35
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,445.44 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $851.14 / $1,318.26