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Tennessee 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
$813.32 / $813.32 / $888.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.25 / $858.50 / $1,522.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,355.84 / $1,355.84 / $1,807.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.08 / $1,627.00 / $1,627.00
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 / $757.19 / $1,037.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,142.89 / $8,839.16 / $10,513.18
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,623.84 / $10,644.35 / $15,885.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.25 / $882.18 / $1,246.24