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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 July 2026.

Facilitymedian $107 · 10th–90th $89$1550%20%40%10th90th$107Professionalmedian $200 · 10th–90th $105$2090%50%10th90th$200$100.0$200.0

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
$69.18
Median
$112.20
Typical High
$204.17
Cigna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$181.97
Typical High
$245.47
HMSA
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$208.93
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$199.53
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$91.20
Typical High
$112.20
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$151.36
Typical High
$239.88