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Washington rates for HCPCS L1904

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

Facilitymedian $525 · 10th–90th $355–$1,3180%20%10th90th$525Professionalmedian $355 · 10th–90th $251–$8130%20%10th90th$355$1.0$5.0$20.0$100.0$500.0$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
$354.81 / $354.81 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $316.23 / $467.74
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $512.86 / $512.86
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $741.31 / $1,513.56
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $676.08 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $407.38 / $446.68
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $512.86 / $524.81
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $588.84
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $776.25 / $1,071.52
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $512.86
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $588.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $724.44 / $870.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $302.00 / $501.19
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $457.09 / $812.83