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California rates for HCPCS L1904

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

Facilitymedian $309 · 10th–90th $240–$1,4130%20%10th90th$309Professionalmedian $316 · 10th–90th $240–$1,9950%20%10th90th$316$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
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $316.23 / $1,995.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $309.03 / $1,412.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $323.59 / $851.14
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $1,047.13 / $1,659.59
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,318.26 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $416.87 / $870.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $645.65 / $1,122.02
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,818.38
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $4,073.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $524.81
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $549.54 / $870.96
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $512.86
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $1,318.26
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $436.52 / $645.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $263.03 / $724.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $316.23 / $724.44