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Oklahoma rates for HCPCS L1904

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, custom fabricated

Facilitymedian $302 · 10th–90th $240–$7760%20%10th90th$302Professionalmedian $275 · 10th–90th $234–$3800%20%10th90th$275$200.0$500.0$1.0K$2.0K

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
$251.19 / $251.19 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $275.42 / $338.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $588.84
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $354.81 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $263.03 / $645.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $363.08 / $616.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $380.19