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

California 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 $166 · 10th–90th $129$5500%20%10th90th$166Professionalmedian $117 · 10th–90th $93$4170%20%40%10th90th$117$0.2$1.0$5.0$20.0$100.0$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
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$851.14
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$117.49
Typical High
$416.87
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$138.04
Typical High
$154.88
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$478.63
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$120.23
Typical High
$245.47
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$316.23
Typical High
$478.63
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$186.21
Typical High
$501.19
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
$125.89
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$239.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$177.83
Typical High
$323.59
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$954.99
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,479.11
Typical High
$1,479.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Providence
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$199.53
Typical High
$263.03
Providence
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$190.55
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$158.49
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$14.79
Median
$89.13
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$102.33
Typical High
$234.42