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Ankle-Foot Orthosis, Single Upright with Stop

South Dakota 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 $427 · 10th–90th $269$6760%10%10th90th$427Professionalmedian $437 · 10th–90th $245$7240%20%10th90th$437$200.0$500.0$1.0K$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$338.84
Typical High
$446.68
Cigna
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$724.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$467.74
Typical High
$933.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$309.03
Typical High
$2,511.89
Midlands
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$436.52
Typical High
$436.52
Midlands
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Midlands
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$891.25
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$489.78
Typical High
$660.69
United
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$229.09
Typical High
$331.13
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$331.13
Typical High
$575.44
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11