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Ankle Orthosis, Gauntlet, Off-the-Shelf

New Jersey 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 $40 · 10th–90th $40$1200%50%90th$40Professionalmedian $51 · 10th–90th $38$1200%10%20%10th90th$51$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
$39.81
Median
$39.81
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$47.86
Typical High
$144.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$117.49
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$57.54
Typical High
$120.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$102.33
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$114.82
Typical High
$158.49
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
United
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$52.48
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$63.10
Typical High
$114.82