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Wisconsin 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 $1,820 · 10th–90th $1,698$3,3110%20%40%10th90th$1,820Professionalmedian $1,202 · 10th–90th $851$2,6920%20%10th90th$1,202$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
$891.25 / $891.25 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $912.01 / $1,584.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $1,819.70 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $4,168.69 / $8,912.51
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $2,570.40 / $3,467.37
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $1,479.11 / $2,137.96
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,238.72 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $1,778.28 / $8,912.51
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $977.24 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $933.25
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $2,884.03
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $2,041.74 / $3,548.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,691.53 / $5,248.07
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $3,630.78 / $10,471.29
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,513.56 / $10,715.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $977.24 / $1,819.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $891.25 / $1,513.56