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Ankle Orthosis, Gauntlet, Off-the-Shelf

North Carolina 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 $89 · 10th–90th $46$1510%20%10th90th$89Professionalmedian $81 · 10th–90th $47$1200%20%10th90th$81$0.1$1.0$10.0$100.0$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
$58.88
Median
$89.13
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$81.28
Typical High
$120.23
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$79.43
Typical High
$100.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$91.20
Typical High
$186.21
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$57.54
Typical High
$60.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$64.57
Medcost
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$60.26
Typical High
$70.79
Medcost
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$81.28
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$67.61
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$45.71
Typical High
$69.18
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$891.25