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Ohio rates for HCPCS L1904

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

Facilitymedian $575 · 10th–90th $295$9330%20%40%10th90th$575Professionalmedian $295 · 10th–90th $240$4790%20%40%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
$295.12 / $416.87 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $295.12 / $380.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $588.84 / $1,174.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $724.44
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $446.68 / $630.96
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $478.63 / $707.95
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
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $331.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $467.74 / $676.08
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $616.60 / $1,148.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $436.52 / $616.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $263.03 / $407.38