go back

Maine rates for HCPCS L1904

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

Facilitymedian $741 · 10th–90th $331–$8910%20%10th90th$741Professionalmedian $324 · 10th–90th $240–$6310%10%20%10th90th$324$200.0$500.0$1.0K$2.0K

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 / $1,096.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $831.76 / $954.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $741.31
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $316.23 / $426.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $263.03 / $363.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $575.44 / $616.60