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Wyoming rates for HCPCS L1904

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

Facilitymedian $288 · 10th–90th $263–$5130%20%10th90th$288Professionalmedian $331 · 10th–90th $251–$5130%20%10th90th$331$200.0$500.0

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
$251.19 / $295.12 / $467.74
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
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
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $263.03 / $295.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $263.03 / $407.38