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Ankle Orthosis, Gauntlet, Off-the-Shelf

Pennsylvania 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 $166 · 10th–90th $44$4570%20%10th90th$166Professionalmedian $62 · 10th–90th $42$1260%20%10th90th$62$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
$43.65
Median
$165.96
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$58.88
Typical High
$144.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$69.18
Typical High
$151.36
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$79.43
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
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
$57.54
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$158.49
Typical High
$229.09
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$74.13
Typical High
$107.15
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$338.84
Typical High
$489.78
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$85.11
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$61.66
Typical High
$87.10
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$177.83
Typical High
$295.12
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$53.70
Typical High
$102.33
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$162.18
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$37.15
Typical High
$53.70
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$380.19
Typical High
$616.60
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$100.00
Typical High
$112.20
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$123.03
Typical High
$123.03
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$52.48
Typical High
$104.71