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Ankle Orthosis, Gauntlet, Off-the-Shelf

New Mexico 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 $263 · 10th–90th $45$1,4450%10%10th90th$263Professionalmedian $72 · 10th–90th $41$2190%10%20%10th90th$72$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$109.65
Median
$109.65
Typical High
$109.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$58.88
Typical High
$229.09
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$104.71
BCBS
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$933.25
Typical High
$1,584.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$95.50
Typical High
$114.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$131.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$173.78
Typical High
$263.03
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$81.28
Typical High
$109.65
Providence
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$114.82
United
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$47.86
Typical High
$123.03
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$44.67
Typical High
$67.61