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Static or Dynamic Ankle-Foot Orthosis, Custom Fitted

Hawaii rates for HCPCS L4396

Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Rates data updated October 2026.

How much does Static or Dynamic Ankle-Foot Orthosis, Custom Fitted cost?

$200

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $200 for this service. Most negotiated rates run $138 to $209.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $155 · 10th to 90th $112 to $155Professionalmedian $200 · 10th to 90th $120 to $214
$100$200facility $155professional $200

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$114.82
Cigna
Setting
Facility
Modifier
None
Typical Low
$112.20
Median
$154.88
Typical High
$154.88
Cigna
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
HMSA
Setting
Professional
Modifier
None
Typical Low
$199.53
Median
$199.53
Typical High
$208.93
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$199.53
Typical High
$257.04
United
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$213.80
Typical High
$213.80
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$120.23

Where Hawaii sits

The same service costs 2.3 times more in Hawaii than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Hawaii· 1st of 51

$200

HI $200DE $85.11

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.