go back

Vermont rates for HCPCS L1904

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

Facilitymedian $331 · 10th–90th $263–$5250%50%10th90th$331Professionalmedian $347 · 10th–90th $219–$3980%50%10th90th$347$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
$218.78 / $346.74 / $398.11
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 / $331.13
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $363.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $436.52 / $812.83