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

Hawaii 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 October 2026.

How much does Static or Dynamic Ankle-Foot Orthosis, Off-the-Shelf cost?

$200

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $200 for this service. Most negotiated rates run $155 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 $107 to $155Professionalmedian $200 · 10th to 90th $151 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
$69.18
Median
$112.20
Typical High
$120.23
Cigna
Setting
Facility
Modifier
None
Typical Low
$107.15
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
$138.04
Median
$199.53
Typical High
$257.04
United
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$213.80
Typical High
$213.80
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$151.36
Typical High
$151.36

Where Hawaii sits

The same service costs 2.1 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 $93.33

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.