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Ankle-Foot Orthosis, Spring Wire, Custom Fabricated

South Carolina rates for HCPCS L1900

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

Rates data updated July 2026.

Facilitymedian $200 · 10th–90th $155$4470%20%10th90th$200Professionalmedian $170 · 10th–90th $132$2950%20%10th90th$170$100.0$200.0$500.0$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
$169.82
Median
$169.82
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$169.82
Typical High
$295.12
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$316.23
Typical High
$346.74
BCBS
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$295.12
Typical High
$426.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$190.55
Typical High
$208.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$398.11
Medcost
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$194.98
Medcost
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$257.04
Typical High
$537.03
Medcost
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$97.72
Molina
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$190.55
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$169.82
Typical High
$229.09