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 | $551 – $586 | $276 | $689 |
| Deaconess Medical Center | $489 – $503 | $276 | $689 |
| Harborview Medical Center | — | $646 – $662 | $923 – $946 |
| Mary Bridge Children's Hospital | $451 – $551 | $276 | $689 |
| MultiCare Auburn Medical Center | $407 – $503 | $276 | $689 |
| MultiCare Covington Medical Center | $407 – $503 | $276 | $689 |
| MultiCare Good Samaritan Hospital | $407 – $503 | $276 | $689 |
| MultiCare Valley Hospital | $496 | $276 | $689 |
| Tacoma General Allenmore Hospital | $407 – $503 | $276 | $689 |
| University of Washington Medical Ctr | — | $818 | $1,169 |
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)