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Ankle Orthosis, Gauntlet, Off-the-Shelf

Kentucky 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 $60 · 10th–90th $45$1380%20%10th90th$60Professionalmedian $49 · 10th–90th $44$1070%20%40%10th90th$49$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
$47.86
Median
$47.86
Typical High
$48.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$107.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$69.18
Typical High
$97.72
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$93.33
Typical High
$100.00
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$43.65
Typical High
$54.95
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$125.89
Typical High
$162.18
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$114.82
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$138.04
Typical High
$138.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$67.61
Typical High
$501.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$61.66
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$44.67
Typical High
$74.13