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Ankle Orthosis, Gauntlet, Off-the-Shelf

Nebraska 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 $98 · 10th–90th $45$4680%20%10th90th$98Professionalmedian $56 · 10th–90th $46$1820%20%10th90th$56$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
$60.26
Median
$60.26
Typical High
$60.26
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$56.23
Typical High
$181.97
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$104.71
Typical High
$147.91
BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$91.20
Typical High
$93.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$104.71
Typical High
$199.53
Medica
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$107.15
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$50.12
Typical High
$114.82
Midlands
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$257.04
Midlands
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Midlands
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$239.88
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$77.62
Typical High
$104.71
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$47.86
Typical High
$89.13