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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$842.83 / $996.99 / $1,144.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,727.31 / $3,683.60 / $4,360.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.85 / $1,303.36 / $1,744.40
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$701.88 / $1,020.92 / $1,603.92