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

New Hampshire 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 $209 · 10th–90th $120$2570%20%10th90th$209Professionalmedian $145 · 10th–90th $89$2040%20%10th90th$145$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$204.17
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$223.87
Typical High
$257.04
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$120.23
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
$93.33
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$331.13
United
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$91.20
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$138.04
Typical High
$181.97
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$223.87