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Rhode Island rates for HCPCS L1904

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

Facilitymedian $1,259 · 10th–90th $331–$1,6220%10%20%10th90th$1,259Professionalmedian $309 · 10th–90th $240–$6610%20%40%10th90th$309$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $309.03 / $1,096.48
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,412.54 / $1,659.59
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $398.11 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $323.59 / $724.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $380.19 / $588.84