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Ankle Orthosis, Gauntlet, Off-the-Shelf

California 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 $52 · 10th–90th $41$2340%20%10th90th$52Professionalmedian $76 · 10th–90th $45$2290%20%10th90th$76$0.1$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
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$588.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$75.86
Typical High
$229.09
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$63.10
Typical High
$83.18
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$52.48
Typical High
$223.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$54.95
Typical High
$123.03
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$162.18
Typical High
$251.19
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$57.54
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$114.82
Typical High
$141.25
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$102.33
Typical High
$190.55
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$891.25
Typical High
$891.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$91.20
Typical High
$125.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$104.71
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$7.41
Median
$44.67
Typical High
$123.03
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$52.48
Typical High
$112.20