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North Carolina rates for HCPCS L1904

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

Facilitymedian $468 · 10th–90th $229–$1,2020%20%10th90th$468Professionalmedian $347 · 10th–90th $240–$4680%20%40%10th90th$347$0.5$5.0$50.0$500.0$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
$467.74 / $467.74 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $338.84 / $467.74
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $524.81
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $407.38
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $263.03 / $426.58
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $467.74 / $794.33
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $549.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $263.03 / $436.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $263.03 / $398.11
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,818.38
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $4,073.80