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Texas 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 $1,445 · 10th–90th $794$4,3650%10%20%10th90th$1,445Professionalmedian $851 · 10th–90th $759$1,2590%50%10th90th$851$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
$794.33 / $794.33 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $870.96 / $1,202.26
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,258.93 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,388.44 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $851.14
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,380.38 / $1,819.70
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $1,819.70 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,047.13
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,120.11 / $9,120.11 / $9,120.11
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10,715.19 / $15,848.93 / $15,848.93
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $1,698.24 / $2,691.53
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $870.96 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,380.38 / $1,412.54
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,584.89 / $2,630.27
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,047.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $1,258.93 / $1,905.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,023.29 / $1,258.93
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,819.70 / $1,819.70