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Iowa rates for HCPCS L1904

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

Facilitymedian $537 · 10th–90th $331–$1,6220%20%10th90th$537Professionalmedian $309 · 10th–90th $240–$5890%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
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $309.03 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $630.96 / $794.33
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $630.96 / $676.08
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $691.83 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $338.84 / $891.25
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $602.56 / $812.83
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $891.25 / $891.25
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
$204.17 / $537.03 / $1,412.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $269.15 / $501.19
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $524.81 / $524.81