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Tennessee rates for HCPCS L1904

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

Facilitymedian $398 · 10th–90th $263–$2,8180%20%10th90th$398Professionalmedian $263 · 10th–90th $234–$4570%20%10th90th$263$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$239.88 / $263.03 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $263.03 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,818.38
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $4,073.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $288.40 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $257.04 / $371.54