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

Iowa 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 $145 · 10th–90th $95$4790%10%20%10th90th$145Professionalmedian $138 · 10th–90th $91$2450%20%10th90th$138$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
$93.33
Median
$141.25
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$128.82
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$234.42
Typical High
$295.12
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$204.17
Typical High
$245.47
Medica
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$239.88
Typical High
$933.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$128.82
Typical High
$323.59
Midlands
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$251.19
Typical High
$524.81
Midlands
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Midlands
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$323.59
Typical High
$323.59
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$269.15
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$199.53
Typical High
$389.05
United
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$97.72
Typical High
$245.47
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$186.21
Typical High
$186.21