go back

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

Wisconsin 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 $204 · 10th–90th $166$3720%50%10th90th$204Professionalmedian $126 · 10th–90th $55$3470%10%10th90th$126$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
$102.33
Median
$102.33
Typical High
$102.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$97.72
Typical High
$186.21
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$338.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$229.09
CareSource
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$457.09
Typical High
$1,047.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$295.12
Typical High
$389.05
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$165.96
Typical High
$239.88
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$223.87
Typical High
$245.47
Medica
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$204.17
Typical High
$933.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$107.15
Typical High
$229.09
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$61.66
Typical High
$70.79
Network Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$239.88
Typical High
$501.19
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$165.96
Typical High
$239.88
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$204.17
Quartz
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$309.03
Typical High
$537.03
Quartz
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$416.87
Typical High
$954.99
Quartz
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$309.03
Typical High
$1,023.29
United
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$104.71
Typical High
$204.17
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$104.71
Typical High
$407.38