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Static or Dynamic Ankle-Foot Orthosis, Off-the-Shelf

Alaska rates for HCPCS L4397

Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $132 · 10th–90th $132$2000%50%90th$132Professionalmedian $115 · 10th–90th $100$2400%20%10th90th$115$100.0$200.0$500.0

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
Professional
Modifier
Global
Typical Low
$100.00
Median
$112.20
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$213.80
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$199.53
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$199.53
Typical High
$630.96
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$190.55
Typical High
$199.53
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$190.55
Typical High
$199.53
Providence
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$208.93
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$125.89
Typical High
$186.21
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$95.50
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$151.36
Typical High
$436.52