HCPCS L1904
Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated
Current codeBelow Knee Orthotic23 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $466 – $3,613 | $276 | $689 |
| Deaconess Medical Center | $256 – $2,249 | $276 | $689 |
| Harborview Medical Center | $865 – $1,081 | $646 – $662 | $923 – $946 |
| Kadlec Regional Medical Center | $815 – $1,518 | — | — |
| Mary Bridge Children's Hospital | $445 – $3,966 | $276 | $689 |
| MultiCare Auburn Medical Center | $453 – $2,335 | $276 | $689 |
| MultiCare Covington Medical Center | $453 – $2,335 | $276 | $689 |
| MultiCare Good Samaritan Hospital | $453 – $2,335 | $276 | $689 |
| MultiCare Valley Hospital | $256 – $2,244 | $276 | $689 |
| Overlake Hospital Medical Center & Clinics | $496 – $1,487 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $837 – $1,793 | — | — |
| Providence Centralia Hospital | $913 – $2,020 | — | — |
| Providence Regional Medical Center Everett | $648 – $1,254 | — | — |
| Providence St Peter Hospital | $459 – $1,764 | — | — |
| Swedish Edmonds Hospital | $811 – $1,982 | — | — |
| Swedish Issaquah | $811 – $1,200 | — | — |
| Swedish Medical Center | $811 – $1,930 | — | — |
| Swedish Medical Center / Cherry Hill | $811 – $1,930 | — | — |
| Tacoma General Allenmore Hospital | $453 – $2,335 | $276 | $689 |
| University of Washington Medical Ctr | $865 – $1,695 | $818 | $1,169 |
| Virginia Mason Medical Center | $517 – $1,879 | — | — |
| Wellfound Behavioral Health Hospital | $1,364 | — | — |
| Yakima Valley Memorial | $466 – $1,402 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Equipment fee, Washington
- $540 (fee)