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Pennsylvania 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 $776$3,0200%20%10th90th$1,905Professionalmedian $933 · 10th–90th $759$1,6980%20%40%10th90th$933$1.0$10.0$100.0$1.0K$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
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $3,019.95 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $912.01 / $1,348.96
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,621.81
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,862.09 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,047.13
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,818.38 / $4,073.80
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,905.46 / $1,905.46
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,348.96 / $1,905.46
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $1,412.54
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $776.25
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $912.01 / $1,348.96
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $3,311.31
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,778.28
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,778.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $2,238.72 / $2,570.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $933.25 / $1,949.84