HCPCS L4055
Replace non-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 | $269 – $2,084 | — | — |
| Deaconess Medical Center | $373 – $1,297 | — | — |
| Harborview Medical Center | $499 – $623 | $382 | $545 |
| Kadlec Regional Medical Center | $470 – $875 | — | — |
| Mary Bridge Children's Hospital | $269 – $2,287 | — | — |
| MultiCare Auburn Medical Center | $261 – $1,346 | — | — |
| MultiCare Covington Medical Center | $261 – $1,346 | — | — |
| MultiCare Good Samaritan Hospital | $303 – $1,346 | — | — |
| MultiCare Valley Hospital | $298 – $1,294 | — | — |
| Overlake Hospital Medical Center & Clinics | $286 – $857 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $483 – $1,034 | — | — |
| Providence Centralia Hospital | $527 – $1,165 | — | — |
| Providence Regional Medical Center Everett | $374 – $723 | — | — |
| Providence St Peter Hospital | $265 – $1,018 | — | — |
| Swedish Edmonds Hospital | $467 – $1,143 | — | — |
| Swedish Issaquah | $467 – $692 | — | — |
| Swedish Medical Center | $467 – $1,113 | — | — |
| Swedish Medical Center / Cherry Hill | $467 – $1,113 | — | — |
| Tacoma General Allenmore Hospital | $261 – $1,346 | — | — |
| University of Washington Medical Ctr | $499 – $977 | — | — |
| Virginia Mason Medical Center | $298 – $1,084 | — | — |
| Wellfound Behavioral Health Hospital | $786 | — | — |
| Yakima Valley Memorial | $269 – $808 | — | — |
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
- $312 (fee)