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Georgia rates for HCPCS L1904

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

Facilitymedian $537 · 10th–90th $251–$1,9950%10%20%10th90th$537Professionalmedian $316 · 10th–90th $245–$5250%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
$251.19 / $251.19 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $295.12 / $467.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $1,288.25 / $1,995.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $436.52 / $707.95
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
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 / $645.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $537.03 / $794.33
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $724.44 / $1,148.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $263.03 / $436.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $263.03 / $512.86