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Ankle-Foot Orthosis, Spring Wire, Custom Fabricated

South Dakota rates for HCPCS L1900

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

Rates data updated July 2026.

Facilitymedian $316 · 10th–90th $219$4570%10%20%10th90th$316Professionalmedian $295 · 10th–90th $200$5010%10%20%10th90th$295$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$239.88
Typical High
$295.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$354.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$501.19
Medica
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$331.13
Typical High
$616.60
Medica
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$1,949.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$346.74
Typical High
$346.74
Midlands
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
Midlands
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$588.84
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$331.13
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$177.83
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$234.42
Typical High
$407.38
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23