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
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $530 – $583 | $276 | $689 |
| Deaconess Medical Center | $530 – $583 | $276 | $689 |
| Harborview Medical Center | $540 – $594 | $646 – $662 | $923 – $946 |
| Kadlec Regional Medical Center | $540 – $648 | — | — |
| Mary Bridge Children's Hospital | $530 – $583 | $276 | $689 |
| MultiCare Auburn Medical Center | $530 – $583 | $276 | $689 |
| MultiCare Covington Medical Center | $530 – $583 | $276 | $689 |
| MultiCare Good Samaritan Hospital | $530 – $583 | $276 | $689 |
| MultiCare Valley Hospital | $545 – $583 | $276 | $689 |
| Overlake Hospital Medical Center & Clinics | $540 – $562 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $540 – $648 | — | — |
| Providence Centralia Hospital | $540 – $865 | — | — |
| Providence Regional Medical Center Everett | $540 – $594 | — | — |
| Providence St Peter Hospital | $540 – $865 | — | — |
| Swedish Edmonds Hospital | $540 – $648 | — | — |
| Swedish Issaquah | $540 – $648 | — | — |
| Swedish Medical Center | $540 – $648 | — | — |
| Swedish Medical Center / Cherry Hill | $540 – $648 | — | — |
| Tacoma General Allenmore Hospital | $530 – $583 | $276 | $689 |
| University of Washington Medical Ctr | $540 – $594 | $818 | $1,169 |
| Virginia Mason Medical Center | $371 – $556 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $530 – $593 | — | — |
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)