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Ankle Orthosis, Gauntlet, Off-the-Shelf

Wisconsin 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 $91 · 10th–90th $60$1660%20%40%10th90th$91Professionalmedian $79 · 10th–90th $42$1410%20%10th90th$79$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
$45.71
Median
$64.57
Typical High
$87.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$63.10
Typical High
$128.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$151.36
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$102.33
CareSource
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$208.93
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$131.83
Typical High
$173.78
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$74.13
Typical High
$112.20
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$134.90
Typical High
$169.82
Medica
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$89.13
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$53.70
Typical High
$102.33
Molina
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$58.88
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Network Health
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$102.33
Typical High
$177.83
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$74.13
Typical High
$112.20
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$89.13
Typical High
$102.33
Quartz
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$138.04
Typical High
$269.15
Quartz
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$186.21
Typical High
$478.63
Quartz
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$138.04
Typical High
$602.56
Security Health
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$83.18
Typical High
$85.11
United
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$91.20
United
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$95.50
Typical High
$204.17