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Ankle-Foot Orthosis, Spring Wire, Custom Fabricated

Washington rates for HCPCS L1900

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

Rates data updated July 2026.

Facilitymedian $339 · 10th–90th $224$7240%20%10th90th$339Professionalmedian $275 · 10th–90th $151$6030%10%10th90th$275$5.0$20.0$100.0$500.0$2.0K

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
$223.87
Median
$223.87
Typical High
$537.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$223.87
Typical High
$1,479.11
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$323.59
Typical High
$338.84
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$380.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$190.55
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$457.09
Typical High
$954.99
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$389.05
Typical High
$707.95
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$257.04
Typical High
$281.84
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$323.59
Typical High
$338.84
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$331.13
Typical High
$676.08
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$489.78
Typical High
$676.08
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$323.59
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$323.59
Typical High
$338.84
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$416.87
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$177.83
Typical High
$295.12
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$288.40
Typical High
$512.86