go back

Ankle Orthosis, Gauntlet, Off-the-Shelf

Texas 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 $87 · 10th–90th $49$2140%10%20%10th90th$87Professionalmedian $58 · 10th–90th $43$1020%50%10th90th$58$0.1$1.0$10.0$100.0$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
$53.70
Median
$56.23
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$56.23
Typical High
$109.65
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$89.13
Typical High
$147.91
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$91.20
Typical High
$125.89
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
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
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$89.13
Typical High
$147.91
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$107.15
Typical High
$123.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$74.13
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Providence
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$89.13
Typical High
$147.91
Providence
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$57.54
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$97.72
Typical High
$123.03
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$54.95
Typical High
$69.18
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$123.03
Typical High
$165.96