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Missouri rates for HCPCS L1904

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

Facilitymedian $437 · 10th–90th $275–$1,2020%20%10th90th$437Professionalmedian $302 · 10th–90th $240–$4680%20%10th90th$302$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
$275.42 / $275.42 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $281.84 / $457.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $1,905.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $323.59 / $501.19
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $426.58 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $263.03 / $3,981.07
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $436.52 / $436.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $263.03 / $407.38