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
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 | $560 – $616 | — | — |
| Deaconess Medical Center | $560 – $616 | — | — |
| Harborview Medical Center | $572 – $629 | $700 | $1,000 |
| Kadlec Regional Medical Center | $572 – $686 | — | — |
| Mary Bridge Children's Hospital | $560 – $616 | — | — |
| MultiCare Auburn Medical Center | $560 – $616 | — | — |
| MultiCare Covington Medical Center | $560 – $616 | — | — |
| MultiCare Good Samaritan Hospital | $560 – $616 | — | — |
| MultiCare Valley Hospital | $577 – $616 | — | — |
| Overlake Hospital Medical Center & Clinics | $572 – $594 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $572 – $686 | — | — |
| Providence Centralia Hospital | $572 – $915 | — | — |
| Providence Regional Medical Center Everett | $572 – $629 | — | — |
| Providence St Peter Hospital | $572 – $915 | — | — |
| Swedish Edmonds Hospital | $572 – $686 | — | — |
| Swedish Issaquah | $572 – $686 | — | — |
| Swedish Medical Center | $572 – $686 | — | — |
| Swedish Medical Center / Cherry Hill | $572 – $686 | — | — |
| Tacoma General Allenmore Hospital | $560 – $616 | — | — |
| University of Washington Medical Ctr | $572 – $629 | — | — |
| Virginia Mason Medical Center | $392 – $588 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $560 – $627 | — | — |
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)