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Ankle Orthosis, Gauntlet, Off-the-Shelf

Idaho 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 $98 · 10th–90th $51$1380%20%10th90th$98Professionalmedian $76 · 10th–90th $43$1230%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
$66.07
Median
$69.18
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$74.13
Typical High
$114.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$107.15
Typical High
$186.21
BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$123.03
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$57.54
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$87.10
Typical High
$123.03
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$107.15
Typical High
$112.20
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$79.43
Typical High
$97.72
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$107.15
Typical High
$107.15
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$123.03
Select Health
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$112.20
Typical High
$169.82
Select Health
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$107.15
Typical High
$120.23
United
Setting
Facility
Modifier
Global
Typical Low
$0.07
Median
$47.86
Typical High
$54.95
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$44.67
Typical High
$66.07