go back

Ankle Orthosis, Gauntlet, Off-the-Shelf

Vermont 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 $56 · 10th–90th $44$580%20%40%10th90th$56Professionalmedian $59 · 10th–90th $48$780%20%10th90th$59$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$50.12
Typical High
$74.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$75.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$57.54
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$102.33
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$44.67
Typical High
$56.23
United
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$69.18
Typical High
$208.93