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Nebraska rates for HCPCS L1904

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

Facilitymedian $589 · 10th–90th $263–$2,7540%20%10th90th$589Professionalmedian $339 · 10th–90th $178–$1,4450%10%20%10th90th$339$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $338.84 / $3,090.30
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $512.86 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $630.96 / $1,023.29
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $602.56 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $263.03 / $537.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $1,445.44
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,318.26 / $1,445.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $316.23 / $616.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $263.03 / $416.87