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Ankle Orthosis, Gauntlet, Off-the-Shelf

Alaska rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $58 · 10th–90th $29$1050%20%40%10th90th$58Professionalmedian $76 · 10th–90th $46$1580%20%10th90th$76$50.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$53.70
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$74.13
Typical High
$102.33
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$109.65
Typical High
$338.84
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$104.71
Typical High
$109.65
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$104.71
Typical High
$109.65
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$104.71
Providence
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$60.26
Typical High
$104.71
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$47.86
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$79.43
Typical High
$218.78