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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 October 2026.

How much does Static or Dynamic Ankle-Foot Orthosis, Off-the-Shelf cost?

$195

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $195 for this service. The price depends on where it is billed: about $195 from a physician practice, and about $257 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$195$123 to $209
FacilityA hospital or hospital-owned outpatient department$257$209 to $11,749

How much rates vary

Facilitymedian $257 · 10th to 90th $204 to $12,023Professionalmedian $195 · 10th to 90th $79 to $224
$100$200$500$1K$2K$5K$10Kfacility $257professional $195

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$75.86
Median
$123.03
Typical High
$190.55
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Cigna
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$208.93
Typical High
$208.93
Cigna
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$208.93
Typical High
$208.93
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$204.17
Median
$398.11
Typical High
$12,589.25
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$223.87
Typical High
$12,589.25
Providence
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$208.93
Typical High
$208.93
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$158.49
Typical High
$208.93
United
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$89.13
Typical High
$151.36

Where Montana sits

The same service costs 2.1 times more in Hawaii than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 4th of 51

$195

HI $200DE $93.33

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.