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

Utah 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 $89 · 10th–90th $78$2000%20%40%10th90th$89Professionalmedian $141 · 10th–90th $78$7080%10%10th90th$141$50.0$100.0$200.0$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
$77.62
Median
$77.62
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$123.03
Typical High
$707.95
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
Molina
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$147.91
Typical High
$186.21
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$199.53
Typical High
$199.53
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$144.54
Typical High
$218.78
Select Health
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Select Health
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$199.53
Typical High
$204.17
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$204.17
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$89.13
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$89.13
Typical High
$151.36