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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.

How much does Static or Dynamic Ankle-Foot Orthosis, Off-the-Shelf cost?

$166

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $158 from a physician practice, and about $191 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$158$135 to $234
FacilityA hospital or hospital-owned outpatient department$191$151 to $234

How much rates vary

Facilitymedian $191 · 10th to 90th $138 to $275Professionalmedian $158 · 10th to 90th $112 to $295
$100$200$500$1Kfacility $191professional $158

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where South Dakota sits

The same service costs 2.5 times more in Minnesota than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 9th of 51

$166

MN $204DC $81.28

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.