go back

Oklahoma 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.18 / $847.18 / $847.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.80 / $847.18 / $996.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.85 / $1,568.85 / $1,568.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.25 / $1,037.25 / $1,037.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.19 / $1,037.25 / $1,037.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.59 / $1,215.80 / $8,839.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.10 / $872.37 / $1,813.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.10 / $828.14 / $1,246.24