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Hawaii rates for HCPCS L1904

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

Facilitymedian $331 · 10th–90th $263–$7760%50%10th90th$331Professionalmedian $316 · 10th–90th $240–$1,0000%20%10th90th$316$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $309.03 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $912.01 / $1,230.27
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,047.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $1,000.00 / $1,148.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $338.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $407.38 / $1,071.52