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Ankle Orthosis, Gauntlet, Off-the-Shelf

Mississippi 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 $72 · 10th–90th $45$1230%20%40%10th90th$72Professionalmedian $55 · 10th–90th $43$890%20%10th90th$55$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
$54.95
Median
$54.95
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$54.95
Typical High
$89.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$77.62
Typical High
$131.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
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
$42.66
Typical High
$57.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$75.86
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$75.86
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$43.65
Typical High
$72.44