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Oklahoma rates for HCPCS L1630

Hip orthosis (HO), abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $112.20 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $229.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $128.82 / $588.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $95.50 / $239.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $151.36 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $91.20 / $138.04