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Ankle-Foot Orthosis, Single Upright with Stop

Pennsylvania rates for HCPCS L1920

Ankle-foot orthosis (AFO), single upright with static or adjustable stop (Phelps or Perlstein type), custom fabricated

Rates data updated July 2026.

Facilitymedian $631 · 10th–90th $162$2,0890%10%20%10th90th$631Professionalmedian $195 · 10th–90th $162$3470%20%40%10th90th$195$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$162.18
Median
$162.18
Typical High
$630.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$190.55
Typical High
$338.84
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
$218.78
Median
$323.59
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$616.60
Cigna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$245.47
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$562.34
Typical High
$812.83
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$281.84
Typical High
$398.11
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$630.96
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$194.98
Typical High
$346.74
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$186.21
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,412.54
Typical High
$2,290.87
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$371.54
Typical High
$467.74
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$537.03
Typical High
$537.03
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$194.98
Typical High
$426.58