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Minnesota rates for HCPCS L1904

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

Facilitymedian $603 · 10th–90th $398–$3,9810%20%10th90th$603Professionalmedian $550 · 10th–90th $282–$6310%20%40%10th90th$550$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
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $316.23 / $407.38
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $549.54 / $707.95
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $549.54 / $549.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $2,041.74 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $724.44 / $794.33
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,041.74 / $3,981.07
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $851.14
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $549.54 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $263.03 / $645.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.27 / $263.03 / $870.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $309.03 / $758.58