go back

Ankle Orthosis, Gauntlet, Off-the-Shelf

Hawaii rates for HCPCS L1902

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

Rates data updated October 2026.

How much does Ankle Orthosis, Gauntlet, Off-the-Shelf cost?

$117

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $117 for this service. Most negotiated rates run $70.79 to $123.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $91 · 10th to 90th $58 to $91Professionalmedian $117 · 10th to 90th $71 to $126
$100facility $91professional $117

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$53.70
Median
$53.70
Typical High
$58.88
Cigna
Setting
Facility
Modifier
None
Typical Low
$57.54
Median
$91.20
Typical High
$91.20
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
HMSA
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$117.49
Typical High
$123.03
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$117.49
Typical High
$151.36
United
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$125.89
Typical High
$125.89
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79

Where Hawaii sits

The same service costs 2.6 times more in Hawaii than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Hawaii· 1st of 51

$117

HI $117DE $44.67

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.