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Michigan rates for HCPCS L1904

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

Facilitymedian $692 · 10th–90th $309–$2,1880%10%20%10th90th$692Professionalmedian $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
$309.03 / $309.03 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $309.03 / $398.11
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $1,621.81 / $3,162.28
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $575.44
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $363.08 / $630.96
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $1,023.29 / $1,148.15
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $436.52 / $660.69
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $363.08 / $588.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $446.68 / $724.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $257.04 / $389.05