go back

South Carolina rates for HCPCS L1904

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

Facilitymedian $339 · 10th–90th $263–$7590%10%20%10th90th$339Professionalmedian $282 · 10th–90th $240–$4680%10%20%10th90th$282$50.0$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
$263.03 / $263.03 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $281.84 / $467.74
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $537.03 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $331.13 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $630.96
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $380.19
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $436.52 / $954.99
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $338.84 / $724.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $263.03 / $354.81