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Arizona rates for HCPCS L1904

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

Facilitymedian $575 · 10th–90th $186–$1,5490%10%10th90th$575Professionalmedian $309 · 10th–90th $240–$5010%20%10th90th$309$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$234.42 / $309.03 / $467.74
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $776.25 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $707.95 / $1,348.96
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 / $331.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $467.74 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $263.03 / $3,981.07
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $363.08 / $575.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $263.03 / $398.11