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Ankle Orthosis, Gauntlet, Off-the-Shelf

Maryland 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 $52 · 10th–90th $34$1070%10%10th90th$52Professionalmedian $54 · 10th–90th $43$1950%20%10th90th$54$50.0$100.0$200.0$500.0

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
$79.43
Median
$79.43
Typical High
$79.43
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$53.70
Typical High
$229.09
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$56.23
Typical High
$74.13
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
$57.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$107.15
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$52.48
Typical High
$85.11
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$53.70
Typical High
$91.20