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

South Carolina 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 $115 · 10th–90th $98$2510%20%10th90th$115Professionalmedian $112 · 10th–90th $85$2090%10%20%10th90th$112$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
$100.00
Median
$100.00
Typical High
$100.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$112.20
Typical High
$204.17
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$154.88
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$208.93
BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$181.97
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$141.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$234.42
Medcost
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$131.83
Typical High
$302.00
Medcost
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$131.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$112.20
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$100.00
Typical High
$151.36