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Oregon rates for HCPCS L1904

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

Facilitymedian $513 · 10th–90th $398$5250%50%10th90th$513Professionalmedian $316 · 10th–90th $240$5890%10%10th90th$316$100.0$500.0$2.0K$10.0K

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
$316.23 / $316.23 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $316.23 / $398.11
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 / $239.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $1,174.90 / $1,412.54
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $562.34
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $426.58 / $588.84
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $512.86 / $524.81
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $524.81 / $562.34
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $457.09 / $724.44
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $467.74 / $562.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $831.76 / $2,089.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $588.84 / $588.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $354.81 / $870.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $263.03 / $501.19