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Alaska rates for HCPCS L1904

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

Facilitymedian $355 · 10th–90th $170–$8710%20%40%10th90th$355Professionalmedian $355 · 10th–90th $269–$1,2590%10%20%10th90th$355$100.0$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
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $316.23 / $776.25
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 / $1,071.52
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $512.86 / $870.96
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $870.96 / $1,621.81
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $891.25 / $933.25
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $891.25 / $933.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $758.58
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $331.13 / $501.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $457.09 / $2,290.87