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Ankle-Foot Orthosis, Single Upright with Stop

Utah 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 $195 · 10th–90th $126$4900%20%40%10th90th$195Professionalmedian $257 · 10th–90th $126$1,7780%10%10th90th$257$50.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$1,778.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$263.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$363.08
Typical High
$467.74
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$489.78
Typical High
$489.78
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$354.81
Typical High
$562.34
Select Health
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
Select Health
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$489.78
Typical High
$512.86
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$501.19
Typical High
$616.60
United
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$194.98
Typical High
$457.09
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$194.98
Typical High
$302.00