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Illinois rates for HCPCS L1904

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

Facilitymedian $617 · 10th–90th $282–$2,8180%20%10th90th$617Professionalmedian $309 · 10th–90th $240–$5500%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
$281.84 / $281.84 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $281.84 / $467.74
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $1,047.13 / $3,715.35
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $416.87 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $588.84
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $630.96 / $812.83
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $446.68 / $870.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $269.15 / $457.09