Static or dynamic ankle-foot orthosis, prefabricated at Dignity Health

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

ORTHO L4396 39X-51

Folsom, CA

See all payers reporting HCPCS L4396 →

Payers reporting HCPCS L4396 at Dignity Health

Negotiated rates from the hospital’s own file: 9 payers, 35 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Kaiser commercial\|all plans fee schedule · inpatient	$59	$90	$72	81%	—	$20 – $224
2	Kaiser medicaid\|all plans fee schedule · inpatient	$59	$90	$72	81%	—	$20 – $224
3	Kaiser medicare\|all plans fee schedule · inpatient	$59	$90	$72	81%	—	$20 – $224
4	Anthem medicaid\|all plans fee schedule · inpatient	$61	$94	$75	81%	—	$20 – $234
5	Molina medicaid\|all plans fee schedule · inpatient	$66	$101	$82	81%	—	$22 – $254
6	UnitedHealthcare medicaid\|< 21 fee schedule · outpatient	$142	$131	$23	18%	—	$85 – $142
7	UnitedHealthcare medicaid\|> 21 fee schedule · outpatient	$142	$131	$23	18%	—	$85 – $142
8	Cigna commercial\|localplus fee schedule · inpatient	$102	$156	$126	81%	—	$34 – $390
9	Kaiser medicaid\|all plans fee schedule · outpatient	$105	$160	$129	81%	—	$35 – $400
10	Cigna commercial\|all other plans fee schedule · inpatient	$135	$207	$167	81%	—	$45 – $517
11	Molina medicaid\|all plans fee schedule · outpatient	$255	$214	$70	33%	—	$85 – $268
12	Cigna commercial\|localplus fee schedule · outpatient	$140	$215	$173	81%	—	$47 – $536
13	Anthem medicaid\|all plans fee schedule · outpatient	$255	$215	$71	33%	—	$85 – $271
14	UnitedHealthcare commercial\|non-options ppo fee schedule · outpatient	$163	$250	$201	81%	—	$54 – $624
15	UnitedHealthcare commercial\|hmo fee schedule · outpatient	$168	$257	$207	81%	—	$56 – $644
16	UnitedHealthcare commercial\|all other plans fee schedule · outpatient	$173	$265	$214	81%	—	$58 – $663
17	Blue Cross Blue Shield commercial\|aco trio fee schedule · inpatient	$179	$273	$220	81%	—	$60 – $683
18	Cigna commercial\|all other plans fee schedule · outpatient	$189	$289	$233	81%	—	$63 – $722
19	First Health commercial\|all plans fee schedule · inpatient	$191	$293	$236	81%	—	$64 – $731
20	First Health commercial\|all plans fee schedule · outpatient	$191	$293	$236	81%	—	$64 – $731
21	Anthem commercial\|connection epo fee schedule · outpatient	$201	$308	$248	81%	—	$67 – $770
22	Kaiser commercial\|all plans fee schedule · outpatient	$201	$308	$248	81%	—	$67 – $770
23	MultiPlan commercial\|all plans fee schedule · inpatient	$209	$320	$258	81%	—	$70 – $800
24	MultiPlan commercial\|all plans fee schedule · outpatient	$209	$320	$258	81%	—	$70 – $800
25	Blue Cross Blue Shield commercial\|aco trio calpers fee schedule · inpatient	$217	$332	$267	81%	—	$72 – $829

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