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Ankle Orthosis, Gauntlet, Off-the-Shelf

Tennessee 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 $72 · 10th–90th $45$5010%20%10th90th$72Professionalmedian $50 · 10th–90th $41$870%20%40%10th90th$50$0.1$0.5$2.0$10.0$50.0$200.0$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
$41.69
Median
$45.71
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$47.86
Typical High
$87.10
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$93.33
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$67.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$57.54
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$891.25
Typical High
$891.25
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$44.67
Typical High
$67.61