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Ankle-Foot Orthosis, Spring Wire, Custom Fabricated

Wisconsin rates for HCPCS L1900

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

Rates data updated July 2026.

Facilitymedian $347 · 10th–90th $257$7080%50%10th90th$347Professionalmedian $324 · 10th–90th $170$5890%20%10th90th$324$0.2$1.0$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
$173.78
Median
$173.78
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$309.03
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$575.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$323.59
Typical High
$389.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$812.83
Typical High
$1,778.28
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$501.19
Typical High
$660.69
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$281.84
Typical High
$436.52
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$467.74
Typical High
$588.84
Medica
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$346.74
Typical High
$1,584.89
Medica
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$181.97
Typical High
$380.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$181.97
Network Health
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
Network Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$398.11
Typical High
$691.83
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$281.84
Typical High
$436.52
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$346.74
Typical High
$346.74
Quartz
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$524.81
Typical High
$912.01
Quartz
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$707.95
Typical High
$1,621.81
Quartz
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$524.81
Typical High
$1,949.84
Security Health
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$316.23
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$177.83
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$316.23