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Ankle Orthosis, Gauntlet, Off-the-Shelf

Arizona 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 $89 · 10th–90th $29$2040%10%10th90th$89Professionalmedian $56 · 10th–90th $41$2000%20%10th90th$56$0.1$0.5$2.0$10.0$50.0$200.0

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
$66.07
Median
$66.07
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$57.54
Typical High
$199.53
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$79.43
Typical High
$104.71
BCBS
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$114.82
Typical High
$223.87
BCBS
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$104.71
Typical High
$213.80
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
$57.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$74.13
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$44.67
Typical High
$588.84
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$83.18
Typical High
$104.71
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$44.67
Typical High
$67.61