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Ankle Orthosis, Gauntlet, Off-the-Shelf

South Dakota rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Rates data updated July 2026.

How much does Ankle Orthosis, Gauntlet, Off-the-Shelf cost?

$79.43

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $79.43 for this service. The price depends on where it is billed: about $79.43 from a physician practice, and about $89.13 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$79.43$61.66 to $105
FacilityA hospital or hospital-owned outpatient department$89.13$75.86 to $105

How much rates vary

Facilitymedian $89 · 10th to 90th $62 to $123Professionalmedian $79 · 10th to 90th $54 to $129
$50$100$200$500facility $89professional $79

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$63.10
Typical High
$95.50
Avera
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Avera
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$95.50
Typical High
$100.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$128.82
Medica
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$93.33
Typical High
$169.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$69.18
Typical High
$588.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$104.71
Typical High
$104.71
Midlands
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Midlands
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$162.18
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$89.13
Typical High
$120.23
United
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$52.48
Typical High
$74.13
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$69.18
Typical High
$104.71
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$95.50

Where South Dakota sits

The same service costs 2.5 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 11th of 51

$79.43

HI $107DC $42.66

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.