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Ankle Orthosis, Gauntlet, Off-the-Shelf

South Carolina 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 $58 · 10th–90th $46$1230%20%10th90th$58Professionalmedian $54 · 10th–90th $44$1120%10%20%10th90th$54$50.0$100.0$200.0$500.0

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
$45.71
Median
$45.71
Typical High
$45.71
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$53.70
Typical High
$114.82
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$85.11
Typical High
$95.50
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$85.11
Typical High
$93.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$85.11
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$57.54
Typical High
$61.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$104.71
Medcost
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$63.10
Medcost
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$79.43
Typical High
$158.49
Medcost
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$53.70
Typical High
$123.03
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$45.71
Typical High
$64.57