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

Tennessee 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 $155 · 10th–90th $89$9550%20%10th90th$155Professionalmedian $100 · 10th–90th $89$1860%20%40%10th90th$100$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
$91.20
Median
$100.00
Typical High
$158.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$100.00
Typical High
$177.83
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$208.93
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$147.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$107.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$954.99
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,479.11
Typical High
$1,479.11
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$97.72
Typical High
$141.25