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New York rates for HCPCS L1904

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

Facilitymedian $363 · 10th–90th $240–$1,0000%10%10th90th$363Professionalmedian $324 · 10th–90th $240–$7410%20%40%10th90th$324$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$186.21 / $436.52 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $295.12 / $416.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $1,122.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $331.13 / $851.14
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $457.09 / $457.09
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $630.96
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $912.01 / $2,137.96
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $562.34 / $1,071.52
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $309.03
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $331.13 / $346.74
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $537.03 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $309.03 / $1,548.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $363.08 / $933.25
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $331.13 / $338.84
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $331.13 / $346.74