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

Maine 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 $240 · 10th–90th $112$2820%20%10th90th$240Professionalmedian $123 · 10th–90th $93$1820%20%10th90th$123$100.0$200.0$500.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$112.20
Typical High
$125.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$245.47
Typical High
$281.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$125.89
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
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$213.80
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$131.83
United
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$89.13
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$177.83
Typical High
$181.97