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Massachusetts rates for HCPCS L1904

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

Facilitymedian $407 · 10th–90th $309–$2,0890%20%10th90th$407Professionalmedian $355 · 10th–90th $251–$6920%20%10th90th$355$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$309.03 / $309.03 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $309.03 / $478.63
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $724.44 / $2,818.38
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $537.03 / $724.44
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $407.38 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $416.87
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $933.25
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $338.84
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $724.44 / $2,818.38
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $537.03 / $724.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $346.74 / $724.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $416.87 / $616.60