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Ankle Orthosis, Gauntlet, Off-the-Shelf

Iowa 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 $74 · 10th–90th $49$2510%10%20%10th90th$74Professionalmedian $63 · 10th–90th $44$1350%10%20%10th90th$63$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
$54.95
Median
$63.10
Typical High
$66.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$63.10
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$104.71
Typical High
$128.82
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$95.50
Typical High
$112.20
Medica
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$120.23
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$58.88
Typical High
$158.49
Midlands
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$112.20
Typical High
$141.25
Midlands
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Midlands
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$158.49
Typical High
$158.49
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$125.89
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$74.13
Typical High
$194.98
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$123.03
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$95.50
Typical High
$95.50