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Pennsylvania rates for HCPCS L1904

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

Facilitymedian $646 · 10th–90th $257$1,0000%20%10th90th$646Professionalmedian $295 · 10th–90th $240$4470%20%40%10th90th$295$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
$257.04 / $1,000.00 / $1,000.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $295.12 / $398.11
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $512.86 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $338.84
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $724.44 / $1,071.52
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $416.87 / $645.65
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $295.12 / $389.05
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $851.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $602.56
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $602.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $724.44 / $831.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $316.23 / $575.44