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Nationwide rates for HCPCS L1904

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

Facilitymedian $427 · 10th–90th $245$1,4130%10%20%10th90th$427Professionalmedian $316 · 10th–90th $240$5620%20%10th90th$316$0.5$5.0$50.0$500.0$5.0K$50.0K$500.0K

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
$239.88 / $302.00 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $295.12 / $467.74
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $331.13 / $1,318.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $331.13 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $794.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $354.81 / $724.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $275.42 / $549.54