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Vermont rates for HCPCS L4631

Ankle Foot Orthosis 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
$941.32 / $941.32 / $1,086.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,560.63 / $1,560.63 / $1,560.63
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 / $1,105.76
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,037.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $1,105.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.57 / $1,230.96 / $2,227.77