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Idaho rates for HCPCS L1904

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

Facilitymedian $501 · 10th–90th $295–$6610%20%10th90th$501Professionalmedian $347 · 10th–90th $245–$5890%10%20%10th90th$347$50.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $316.23 / $467.74
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $512.86 / $851.14
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $588.84 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $467.74 / $588.84
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $489.78 / $537.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $380.19 / $467.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $512.86 / $512.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $562.34
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $537.03 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $309.03 / $363.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $263.03 / $380.19