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

New York 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 $126 · 10th–90th $85$3020%10%20%10th90th$126Professionalmedian $120 · 10th–90th $85$2880%20%10th90th$120$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$69.18
Median
$95.50
Typical High
$223.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$120.23
Typical High
$275.42
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$398.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$323.59
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$165.96
Typical High
$165.96
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$281.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$134.90
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$331.13
Typical High
$776.25
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$380.19
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$123.03
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$131.83
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$190.55
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$104.71
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$131.83
Typical High
$323.59
Univera
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$141.25
Univera
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$125.89
Typical High
$131.83