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

Wyoming 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 $100 · 10th–90th $89$1950%20%40%10th90th$100Professionalmedian $112 · 10th–90th $76$1950%20%10th90th$112$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$112.20
Typical High
$173.78
BCBS
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
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
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$91.20
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$89.13
Typical High
$151.36