HCPCS L1990
Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated
Current codeBelow Knee Orthotic26 hospitals with prices
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | — | — | — |
| Deaconess Medical Center | — | — | — |
| Harborview Medical Center | — | $786 – $798 | $1,123 – $1,141 |
| Kadlec Regional Medical Center | — | — | — |
| Mary Bridge Children's Hospital | — | — | — |
| MultiCare Auburn Medical Center | — | — | — |
| MultiCare Covington Medical Center | — | — | — |
| MultiCare Good Samaritan Hospital | — | — | — |
| MultiCare Valley Hospital | — | — | — |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| PeaceHealth Southwest Medical Cente | $678 | $753 | $1,158 |
| PeaceHealth St John Medical Center | $508 – $684 | $664 | $1,021 |
| PeaceHealth St Joseph Medical Center | $684 | $720 | $1,107 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | — | — |
| Providence Centralia Hospital | — | — | — |
| Providence Regional Medical Center Everett | — | — | — |
| Providence St Peter Hospital | — | — | — |
| Swedish Edmonds Hospital | — | $809 | $1,685 |
| Swedish Issaquah | — | $809 | $1,685 |
| Swedish Medical Center | — | $931 | $1,940 |
| Swedish Medical Center / Cherry Hill | — | $945 | $1,969 |
| Tacoma General Allenmore Hospital | — | — | — |
| University of Washington Medical Ctr | — | $1,108 | $1,582 |
| Virginia Mason Medical Center | — | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | — | — | — |
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
- $652 (fee)