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

Montana 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 $195 · 10th–90th $155$2880%20%40%10th90th$195Professionalmedian $126 · 10th–90th $78$3800%20%10th90th$126$100.0$200.0$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
Professional
Modifier
Global
Typical Low
$77.62
Median
$112.20
Typical High
$707.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$208.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$208.93
Typical High
$208.93
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$194.98
Typical High
$380.19
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$194.98
Typical High
$380.19
Providence
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$199.53
Typical High
$239.88
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$158.49
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$95.50
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$89.13
Typical High
$141.25