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

Michigan 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 $269 · 10th–90th $115$7590%20%10th90th$269Professionalmedian $115 · 10th–90th $98$2140%20%40%10th90th$115$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
$114.82
Median
$269.15
Typical High
$269.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$112.20
Typical High
$213.80
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$151.36
Typical High
$154.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$602.56
Typical High
$1,174.90
BCBS
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$208.93
CareSource
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$245.47
Typical High
$389.05
CareSource
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$281.84
Typical High
$288.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$125.89
Typical High
$223.87
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$186.21
Typical High
$208.93
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$114.82
Typical High
$245.47
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$165.96
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$95.50
Typical High
$158.49