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

Texas 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 $158 · 10th–90th $91$5750%10%20%10th90th$158Professionalmedian $98 · 10th–90th $87$1700%50%10th90th$98$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$91.20
Median
$93.33
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$100.00
Typical High
$194.98
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$154.88
Typical High
$208.93
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$165.96
Typical High
$194.98
Christus
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$125.89
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$194.98
Typical High
$281.84
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$186.21
Typical High
$208.93
Molina
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Providence
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$181.97
Typical High
$288.40
Providence
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$165.96
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$141.25
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$208.93
Typical High
$281.84