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Ankle Orthosis, Gauntlet, Off-the-Shelf

Georgia 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 $93 · 10th–90th $44$3470%10%20%10th90th$93Professionalmedian $63 · 10th–90th $44$1290%10%20%10th90th$63$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
$43.65
Median
$107.15
Typical High
$524.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$61.66
Typical High
$131.83
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$123.03
Typical High
$165.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$223.87
Typical High
$346.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$77.62
Typical High
$123.03
CareSource
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$134.90
CareSource
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$120.23
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$138.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$112.20
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$93.33
Typical High
$134.90
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$123.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$125.89
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$45.71
Typical High
$91.20