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Virginia rates for HCPCS L1904

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

Facilitymedian $646 · 10th–90th $288–$8130%20%40%10th90th$646Professionalmedian $316 · 10th–90th $257–$5370%20%10th90th$316$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
$257.04 / $309.03 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $309.03 / $467.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $691.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $676.08
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $645.65 / $912.01
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $426.58 / $630.96
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $416.87 / $724.44
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $346.74 / $812.83
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $524.81 / $1,380.38
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $524.81 / $1,380.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $281.84 / $645.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $316.23 / $512.86