go back

Ankle Orthosis, Gauntlet, Off-the-Shelf

Michigan 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 $148 · 10th–90th $51$2400%20%10th90th$148Professionalmedian $76 · 10th–90th $50$1100%20%10th90th$76$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
$51.29
Median
$147.91
Typical High
$186.21
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$66.07
Typical High
$109.65
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$58.88
Typical High
$69.18
BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$269.15
Typical High
$512.86
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$93.33
CareSource
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$112.20
Typical High
$177.83
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$128.82
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$57.54
Typical High
$112.20
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$169.82
Typical High
$190.55
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$69.18
Typical High
$109.65
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$74.13
Typical High
$112.20
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$74.13
Typical High
$123.03
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$44.67
Typical High
$83.18