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Ankle Orthosis, Gauntlet, Off-the-Shelf

Utah 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 $59 · 10th–90th $52$890%20%10th90th$59Professionalmedian $65 · 10th–90th $31$2340%10%10th90th$65$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
$52.48
Median
$58.88
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$61.66
Typical High
$288.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$57.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$66.07
Typical High
$85.11
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$89.13
Typical High
$89.13
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$64.57
Typical High
$123.03
Select Health
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Select Health
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$91.20
Typical High
$112.20
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$91.20
Typical High
$134.90
United
Setting
Facility
Modifier
Global
Typical Low
$37.15
Median
$44.67
Typical High
$83.18
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$44.67
Typical High
$72.44