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New Mexico rates for HCPCS L1904

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

Facilitymedian $380 · 10th–90th $170–$6460%10%10th90th$380Professionalmedian $288 · 10th–90th $240–$4790%20%10th90th$288$100.0$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
$257.04 / $257.04 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $288.40 / $398.11
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $426.58 / $501.19
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 / $239.88 / $660.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $524.81 / $794.33
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $389.05 / $645.65
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $549.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $295.12 / $724.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $263.03 / $398.11