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

Illinois 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 $105$5500%20%10th90th$166Professionalmedian $129 · 10th–90th $93$2140%20%10th90th$129$0.2$1.0$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
$104.71
Median
$104.71
Typical High
$204.17
Aetna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$112.20
Typical High
$204.17
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$154.88
Typical High
$173.78
BCBS
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$331.13
Typical High
$1,995.26
BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$158.49
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$234.42
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$239.88
Typical High
$338.84
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$123.03
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$165.96
Typical High
$204.17
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$100.00
Typical High
$288.40