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Ankle Orthosis, Gauntlet, Off-the-Shelf

Maine 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 $107 · 10th–90th $51$1320%20%10th90th$107Professionalmedian $59 · 10th–90th $46$910%20%10th90th$59$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$53.70
Typical High
$63.10
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$123.03
Typical High
$141.25
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$72.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$75.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$57.54
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$109.65
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$56.23
Typical High
$63.10
United
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$44.67
Typical High
$57.54
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$89.13
Typical High
$91.20