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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 October 2026.

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

$89.13

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $89.13 for this service. The price depends on where it is billed: about $89.13 from a physician practice, and about $105 from a hospital or other facility.

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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$89.13$60.26 to $105
FacilityA hospital or hospital-owned outpatient department$105$87.10 to $105

How much rates vary

Facilitymedian $105 · 10th to 90th $65 to $170Professionalmedian $89 · 10th to 90th $43 to $115
$50$100$200$500facility $105professional $89

Distribution of negotiated rates across all payers (price axis is log-scale). 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
None
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Aetna
Setting
Professional
Modifier
None
Typical Low
$53.70
Median
$61.66
Typical High
$64.57
Cigna
Setting
Facility
Modifier
None
Typical Low
$57.54
Median
$57.54
Typical High
$107.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$104.71
Median
$104.71
Typical High
$128.82
Medica
Setting
Facility
Modifier
None
Typical Low
$64.57
Median
$104.71
Typical High
$169.82
Medica
Setting
Professional
Modifier
None
Typical Low
$35.48
Median
$60.26
Typical High
$588.84
Midlands
Setting
Professional
Modifier
None
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
Midlands
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Midlands
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$87.10
Typical High
$162.18
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$89.13
Typical High
$102.33
United
Setting
Professional
Modifier
None
Typical Low
$35.48
Median
$50.12
Typical High
$74.13
Wellmark
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$95.50

Where South Dakota sits

The same service costs 2.6 times more in Hawaii than in Delaware. 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· 8th of 51

$89.13

HI $117DE $44.67

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.