HCPCS L4050
Replace molded calf lacer, for custom fabricated orthosis only
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 | $493 – $3,822 | — | — |
| Deaconess Medical Center | $684 – $2,379 | — | — |
| Harborview Medical Center | $915 – $1,143 | $700 | $1,000 |
| Kadlec Regional Medical Center | $862 – $1,606 | — | — |
| Mary Bridge Children's Hospital | $493 – $4,195 | — | — |
| MultiCare Auburn Medical Center | $479 – $2,470 | — | — |
| MultiCare Covington Medical Center | $479 – $2,470 | — | — |
| MultiCare Good Samaritan Hospital | $556 – $2,470 | — | — |
| MultiCare Valley Hospital | $547 – $2,374 | — | — |
| Overlake Hospital Medical Center & Clinics | $524 – $1,573 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $885 – $1,896 | — | — |
| Providence Centralia Hospital | $966 – $2,137 | — | — |
| Providence Regional Medical Center Everett | $686 – $1,326 | — | — |
| Providence St Peter Hospital | $486 – $1,866 | — | — |
| Swedish Edmonds Hospital | $857 – $2,097 | — | — |
| Swedish Issaquah | $857 – $1,269 | — | — |
| Swedish Medical Center | $857 – $2,042 | — | — |
| Swedish Medical Center / Cherry Hill | $857 – $2,042 | — | — |
| Tacoma General Allenmore Hospital | $479 – $2,470 | — | — |
| University of Washington Medical Ctr | $915 – $1,793 | — | — |
| Virginia Mason Medical Center | $547 – $1,988 | — | — |
| Wellfound Behavioral Health Hospital | $1,442 | — | — |
| Yakima Valley Memorial | $493 – $1,483 | — | — |
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
- $572 (fee)