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Ankle Orthosis, Gauntlet, Off-the-Shelf

Ohio 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 $95 · 10th–90th $55$1410%20%10th90th$95Professionalmedian $55 · 10th–90th $43$1100%20%10th90th$55$0.1$0.5$2.0$10.0$50.0$200.0

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
$54.95
Median
$93.33
Typical High
$141.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$56.23
Typical High
$93.33
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$69.18
Typical High
$120.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$194.98
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$54.95
Typical High
$120.23
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$91.20
Typical High
$91.20
CareSource
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$112.20
Typical High
$128.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$125.89
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$74.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$64.57
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$25.70
Median
$57.54
Typical High
$104.71
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$52.48
Typical High
$109.65
Molina
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$54.95
Typical High
$79.43
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$104.71
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$74.13
Typical High
$104.71
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$72.44