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Ankle Orthosis, Gauntlet, Off-the-Shelf

New York 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 $74 · 10th–90th $46$1820%10%10th90th$74Professionalmedian $69 · 10th–90th $44$1820%20%10th90th$69$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$39.81
Median
$74.13
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$74.13
Typical High
$169.82
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$70.79
Typical High
$74.13
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$239.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$186.21
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$97.72
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$138.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$104.71
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$199.53
Typical High
$457.09
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$120.23
Typical High
$229.09
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$47.86
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$67.61
Typical High
$72.44
Fidelis
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.90
Typical High
$107.15
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$102.33
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$114.82
Typical High
$134.90
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$52.48
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$77.62
Typical High
$204.17
Univera
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$67.61
Typical High
$67.61
Univera
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$67.61
Typical High
$72.44