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Indiana rates for HCPCS L1904

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

Facilitymedian $550 · 10th–90th $269–$6610%50%10th90th$550Professionalmedian $295 · 10th–90th $245–$4680%50%10th90th$295$0.5$2.0$10.0$50.0$200.0$1.0K

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
$269.15 / $269.15 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $281.84 / $426.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $549.54 / $691.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $323.59 / $549.54
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $691.83 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $501.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $354.81 / $446.68
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $269.15 / $398.11