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Ankle Orthosis, Gauntlet, Off-the-Shelf

Arkansas 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 $301,995 · 10th–90th $45$891,2510%10%20%10th90th$301,995Professionalmedian $62 · 10th–90th $38$1100%20%40%10th90th$62$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$66.07
Typical High
$275.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$61.66
Typical High
$109.65
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$97.72
Typical High
$97.72
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218,776.16
Median
$524,807.46
Typical High
$954,992.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$138.04
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$128.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$42.66
Typical High
$69.18
Qualchoice
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$112.20
Typical High
$112.20
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$47.86
Typical High
$123.03
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$53.70
Typical High
$70.79