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Ankle Orthosis, Gauntlet, Off-the-Shelf

Massachusetts 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 $126 · 10th–90th $46$2040%20%10th90th$126Professionalmedian $91 · 10th–90th $46$2000%20%10th90th$91$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$44.67
Median
$45.71
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$64.57
Typical High
$288.40
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$107.15
Typical High
$501.19
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$79.43
Typical High
$125.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$134.90
Typical High
$177.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$93.33
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$72.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$61.66
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$138.04
Health New England
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
Health New England
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$56.23
Typical High
$60.26
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$107.15
Typical High
$501.19
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$79.43
Typical High
$125.89
Tufts
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$81.28
Typical High
$81.28
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$54.95
Typical High
$123.03
United
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$83.18
Typical High
$97.72