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Ankle-Foot Orthosis, Spring Wire, Custom Fabricated

Pennsylvania rates for HCPCS L1900

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

Rates data updated July 2026.

Facilitymedian $479 · 10th–90th $126$1,6220%10%20%10th90th$479Professionalmedian $151 · 10th–90th $123$2450%20%40%10th90th$151$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$125.89
Median
$125.89
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$147.91
Typical High
$239.88
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$245.47
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$407.38
Typical High
$588.84
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$218.78
Typical High
$309.03
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$478.63
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$263.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$1,096.48
Typical High
$1,778.28
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$288.40
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$416.87
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$151.36
Typical High
$309.03