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West Virginia 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
Facility
Modifier
Low / Median / High Price
$968.74 / $968.74 / $968.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.75 / $927.14 / $996.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,218.83 / $2,440.50 / $3,281.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.83 / $1,312.60 / $2,169.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $2,172.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $9,103.58
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,191.71 / $1,191.71 / $1,191.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.74 / $985.44 / $1,830.10