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Ankle-Foot Orthosis, Single Upright with Stop

Wisconsin 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 $501 · 10th–90th $372$1,0230%50%10th90th$501Professionalmedian $468 · 10th–90th $240$7940%10%20%10th90th$468$0.5$2.0$10.0$50.0$200.0$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
$251.19
Median
$251.19
Typical High
$251.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$354.81
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$831.76
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$467.74
Typical High
$562.34
Cigna
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$1,174.90
Typical High
$2,570.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$724.44
Typical High
$954.99
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$407.38
Typical High
$630.96
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$616.60
Typical High
$776.25
Medica
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$489.78
Typical High
$2,089.30
Medica
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$245.47
Typical High
$537.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$213.80
Network Health
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
Network Health
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$575.44
Typical High
$1,000.00
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$407.38
Typical High
$630.96
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$407.38
Typical High
$489.78
Quartz
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$758.58
Typical High
$1,174.90
Quartz
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$1,023.29
Typical High
$2,137.96
Quartz
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$758.58
Typical High
$2,570.40
Security Health
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$457.09
Typical High
$467.74
United
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$229.09
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$245.47
Typical High
$426.58