HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Current code24 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

Prices for HCPCS L2628 by hospital
HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27$2,212 – $17,16319 plans$1,309$3,272
Deaconess Medical CenterSpokaneFile dated 2026-08-27$1,216 – $10,68316 plans$1,309$3,272
Harborview Medical CenterSeattleFile dated 2026-04-01$4,107 – $5,1342 plans$3,145$4,492
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01$3,871 – $7,2115 plans——
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27$2,113 – $18,84018 plans$1,309$3,272
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$2,150 – $11,09120 plans$1,309$3,272
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27$2,150 – $11,09120 plans$1,309$3,272
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$2,150 – $11,09120 plans$1,309$3,272
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$1,216 – $10,65916 plans$1,309$3,272
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01$2,354 – $7,06210 plans——
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01$3,976 – $8,5169 plans——
Providence Centralia HospitalCentraliaFile dated 2026-04-01$4,338 – $9,5985 plans——
Providence Regional Medical Center EverettEverettFile dated 2026-04-01$3,080 – $5,9557 plans——
Providence St Peter HospitalOlympiaFile dated 2026-04-01$2,182 – $8,3818 plans——
Seattle Children's HospitalSeattle$3,731 – $6,63398 plans$6,910$6,910
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01$3,850 – $9,4167 plans——
Swedish IssaquahIssaquahFile dated 2026-04-01$3,850 – $5,6997 plans——
Swedish Medical CenterSeattleFile dated 2026-04-01$3,850 – $9,1699 plans——
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01$3,850 – $9,1699 plans——
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$2,150 – $11,09120 plans$1,309$3,272
University of Washington Medical CtrSeattleFile dated 2026-04-01$4,107 – $8,0505 plans——
Virginia Mason Medical CenterSeattle$2,458 – $8,9277 plans——
Wellfound Behavioral Health HospitalTacomaFile dated 2026-08-27$6,4781 plan——
Yakima Valley MemorialYakimaFile dated 2026-08-27$1,603 – $6,65919 plans$1,309$3,272

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

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
$2,567 (fee)