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Ankle-Foot Orthosis, Spring Wire, Custom Fabricated

Hawaii rates for HCPCS L1900

Ankle-foot orthosis (AFO), spring wire, dorsiflexion assist calf band, custom fabricated

Rates data updated July 2026.

Facilitymedian $191 · 10th–90th $151$2880%20%40%10th90th$191Professionalmedian $372 · 10th–90th $102$3890%50%10th90th$372$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
$102.33
Median
$102.33
Typical High
$177.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$288.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$338.84
Typical High
$457.09
HMSA
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$389.05
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$371.54
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$251.19
Typical High
$457.09