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Ankle Orthosis, Gauntlet, Off-the-Shelf

Oregon 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 $100 · 10th–90th $83$1100%20%40%10th90th$100Professionalmedian $81 · 10th–90th $43$1290%20%10th90th$81$0.1$1.0$10.0$100.0$1.0K

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
$93.33
Median
$93.33
Typical High
$93.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$75.86
Typical High
$144.54
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
$42.66
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$199.53
Typical High
$239.88
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$83.18
Typical High
$112.20
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$89.13
Typical High
$123.03
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$107.15
Typical High
$109.65
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$109.65
Typical High
$114.82
Providence
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$91.20
Typical High
$125.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$95.50
Typical High
$114.82
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$114.82
Typical High
$436.52
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$123.03
Typical High
$123.03
United
Setting
Facility
Modifier
Global
Typical Low
$0.07
Median
$44.67
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$44.67
Typical High
$85.11