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

Ohio 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 $204 · 10th–90th $110$3470%20%40%10th90th$204Professionalmedian $112 · 10th–90th $93$2450%20%10th90th$112$0.2$1.0$5.0$20.0$100.0$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
Facility
Modifier
Global
Typical Low
$109.65
Median
$151.36
Typical High
$190.55
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$109.65
Typical High
$204.17
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$223.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$218.78
Typical High
$436.52
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$120.23
Typical High
$269.15
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
CareSource
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$245.47
Typical High
$281.84
CareSource
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$275.42
Typical High
$323.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$141.25
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$109.65
Typical High
$158.49
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$229.09
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$165.96
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$97.72
Typical High
$151.36