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

South Dakota 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 $191 · 10th–90th $138$2750%10%10th90th$191Professionalmedian $158 · 10th–90th $112$2950%10%10th90th$158$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$138.04
Typical High
$169.82
Avera
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$218.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$295.12
Medica
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$194.98
Typical High
$380.19
Medica
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$141.25
Typical High
$1,000.00
Midlands
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$213.80
Typical High
$213.80
Midlands
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Midlands
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$363.08
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$199.53
Typical High
$263.03
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$104.71
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$141.25
Typical High
$239.88
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21