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Washington 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 $2,042 · 10th–90th $1,318$4,6770%20%10th90th$2,042Professionalmedian $1,202 · 10th–90th $794$2,6920%20%10th90th$1,202$1.0$5.0$20.0$100.0$500.0$2.0K$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
$1,202.26 / $1,202.26 / $2,884.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,000.00 / $1,584.89
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,380.38 / $1,380.38
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,737.80 / $1,737.80
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $2,041.74
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,884.03 / $5,495.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,630.27 / $4,265.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,380.38 / $1,513.56
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,737.80 / $1,819.70
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,754.23 / $3,630.78
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $1,479.11 / $1,737.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $2,041.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $954.99 / $1,584.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,548.82 / $2,754.23