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 July 2026.

Facilitymedian $56 · 10th–90th $45$910%20%40%10th90th$56Professionalmedian $107 · 10th–90th $46$1230%20%40%10th90th$107$50.0$100.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$53.70
Typical High
$107.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$91.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$107.15
Typical High
$144.54
HMSA
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$123.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$117.49
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$74.13
Typical High
$141.25