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

Vermont 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 $107 · 10th–90th $71$1260%20%10th90th$107Professionalmedian $123 · 10th–90th $105$2040%20%10th90th$123$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$123.03
Typical High
$204.17
BCBS
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$125.89
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$89.13
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$151.36
Typical High
$416.87