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Ankle Orthosis, Gauntlet, Off-the-Shelf

Montana rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Rates data updated October 2026.

How much does Ankle Orthosis, Gauntlet, Off-the-Shelf cost?

$87.10

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $87.10 for this service. The price depends on where it is billed: about $87.10 from a physician practice, and about $100 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$87.10$72.44 to $95.50
FacilityA hospital or hospital-owned outpatient department$100$91.20 to $5,248

How much rates vary

Facilitymedian $100 · 10th to 90th $69 to $5,370Professionalmedian $87 · 10th to 90th $45 to $100
$50$100$200$500$1K$2K$5Kfacility $100professional $87

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$35.48
Median
$58.88
Typical High
$95.50
BCBS Montana
Setting
Facility
Modifier
None
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
Cigna
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$95.50
Typical High
$95.50
Cigna
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$95.50
Typical High
$95.50
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$114.82
Typical High
$5,370.32
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$112.20
Typical High
$5,623.41
Providence
Setting
Facility
Modifier
None
Typical Low
$51.29
Median
$95.50
Typical High
$95.50
Providence
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$79.43
Typical High
$95.50
United
Setting
Professional
Modifier
None
Typical Low
$41.69
Median
$44.67
Typical High
$74.13

Where Montana sits

The same service costs 2.6 times more in Hawaii than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 9th of 51

$87.10

HI $117DE $44.67

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.