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Ankle-Foot Orthosis, Single Upright with Stop

Washington 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 $490 · 10th–90th $339$9770%10%20%10th90th$490Professionalmedian $417 · 10th–90th $195$7760%10%10th90th$417$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
$338.84
Median
$338.84
Typical High
$812.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$338.84
Typical High
$1,778.28
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$489.78
Typical High
$501.19
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$562.34
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
$245.47
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$588.84
Typical High
$1,445.44
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$549.54
Typical High
$912.01
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$389.05
Typical High
$426.58
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$489.78
Typical High
$501.19
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$501.19
Typical High
$501.19
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$741.31
Typical High
$1,000.00
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$489.78
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$501.19
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$562.34
United
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$537.03
Typical High
$645.65
United
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$229.09
Typical High
$389.05
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$436.52
Typical High
$776.25