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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 October 2026.

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

$57.54

Typical negotiated rate. In New Jersey, October 2026.

Insurers have agreed to pay about $57.54 for this service. The price depends on where it is billed: about $58.88 from a physician practice, and about $57.54 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$58.88$42.66 to $120
FacilityA hospital or hospital-owned outpatient department$57.54$51.29 to $57.54

How much rates vary

Facilitymedian $58 · 10th to 90th $44 to $105Professionalmedian $59 · 10th to 90th $40 to $120
$50$100$200facility $58professional $59

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$39.81
Median
$39.81
Typical High
$45.71
Aetna
Setting
Professional
Modifier
None
Typical Low
$39.81
Median
$39.81
Typical High
$58.88
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$19.95
Median
$19.95
Typical High
$25.70
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$7.94
Median
$7.94
Typical High
$10.23
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$6.03
Median
$6.03
Typical High
$7.76
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$3.98
Median
$3.98
Typical High
$5.13
Ambetter
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$120.23
Typical High
$125.89
AmeriHealth
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$93.33
Typical High
$199.53
Cigna
Setting
Facility
Modifier
None
Typical Low
$57.54
Median
$57.54
Typical High
$120.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$42.66
Median
$42.66
Typical High
$57.54
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$158.49
Typical High
$158.49
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
United
Setting
Facility
Modifier
None
Typical Low
$43.65
Median
$51.29
Typical High
$104.71
United
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$61.66
Typical High
$114.82

Where New Jersey 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.

New Jersey· 28th of 51

$57.54

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.