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

Virginia 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 $200 · 10th–90th $98$2140%20%40%10th90th$200Professionalmedian $112 · 10th–90th $81$1950%20%40%10th90th$112$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
$81.28
Median
$97.72
Typical High
$97.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$97.72
Typical High
$138.04
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$213.80
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$239.88
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$199.53
Typical High
$281.84
Medcost
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$131.83
Typical High
$213.80
Medcost
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$123.03
Typical High
$251.19
Sentara
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$275.42
Sentara
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$91.20
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$162.18