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

Washington 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 $158$4790%20%10th90th$200Professionalmedian $162 · 10th–90th $112$3390%10%20%10th90th$162$2.0$10.0$50.0$200.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$131.83
Typical High
$245.47
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$199.53
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$190.55
Typical High
$194.98
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$218.78
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$309.03
Typical High
$588.84
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$281.84
Typical High
$436.52
Molina
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$147.91
Typical High
$162.18
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$194.98
Typical High
$199.53
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$295.12
Typical High
$389.05
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$190.55
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$194.98
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$218.78
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$295.12
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$104.71
Typical High
$177.83
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$169.82
Typical High
$295.12