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

Pennsylvania 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 $186 · 10th–90th $81$3160%20%10th90th$186Professionalmedian $112 · 10th–90th $81$2140%20%10th90th$112$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
$81.28
Median
$81.28
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$109.65
Typical High
$213.80
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$199.53
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$123.03
Typical High
$147.91
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$281.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$263.03
Typical High
$380.19
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$141.25
Typical High
$199.53
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$158.49
Typical High
$194.98
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$123.03
Typical High
$134.90
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$316.23
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$107.15
Typical High
$162.18
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$398.11
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$245.47
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$100.00
Typical High
$223.87