HCPCS L4387

Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf

Current codeBelow Knee Orthotic30 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.

Prices for HCPCS L4387 by hospital
HospitalMedicare Advantage rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27—$93.60 – $96.80$234 – $242
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$93.60 – $96.80$234 – $242
Highline Medical CenterBurienFile dated 2026-02-28—$56.12$184
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$93.60 – $96.80$234 – $242
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$93.60 – $96.80$234 – $242
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$93.60 – $96.80$234 – $242
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$93.60 – $96.80$234 – $242
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$93.60 – $96.80$234 – $242
St Anthony HospitalGig HarborFile dated 2026-02-28—$55.90$184
St Clare HospitalLakewoodFile dated 2026-02-28—$52.98$184
St Elizabeth HospitalEnumclawFile dated 2026-02-28—$64.95$184
St Francis Community HospitalFederal WayFile dated 2026-02-28—$57.68$184
St Joseph Medical CenterTacomaFile dated 2026-02-28—$60.87$184
St Michael Medical CenterSilverdaleFile dated 2026-02-28—$81.12$184
Swedish IssaquahIssaquahFile dated 2026-04-01—$252$526
Swedish Medical CenterSeattleFile dated 2026-04-01—$252$526
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$252$526
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$93.60 – $96.80$234 – $242
Yakima Valley MemorialYakimaFile dated 2026-08-27—$56.40 – $96.80$141 – $242

Lowest and highest amounts each hospital lists for this code during a hospital stay, 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
$190 (fee)