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Ankle Orthosis, Gauntlet, Off-the-Shelf

Illinois 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 $76 · 10th–90th $46$2040%20%10th90th$76Professionalmedian $65 · 10th–90th $46$1120%20%10th90th$65$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
$45.71
Median
$66.07
Typical High
$141.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$61.66
Typical High
$109.65
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$69.18
Typical High
$123.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$173.78
Typical High
$616.60
BCBS
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$69.18
Typical High
$69.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$60.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$104.71
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$100.00
Typical High
$151.36
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Molina
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$25.70
Typical High
$36.31
United
Setting
Facility
Modifier
Global
Typical Low
$44.67
Median
$74.13
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$79.43
Typical High
$154.88