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HCPCS L5673

Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism

Current codeBelow Knee Orthotic24 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid (state program): Washington Apple Health fee-for-service. Applies only to Medicaid enrollees.

HospitalMedicaid (state program) rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27—$447$1,118
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$447$1,118
Harborview Medical CenterSeattleFile dated 2026-04-01—$1,062 – $1,074$1,517 – $1,535
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$447$1,118
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$447$1,118
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$447$1,118
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$447$1,118
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$447$1,118
Seattle Children's HospitalSeattle$544 – $1,0891 plan$2,158 – $4,321$2,158 – $4,321
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$1,067$2,222
Swedish IssaquahIssaquahFile dated 2026-04-01—$1,067 – $1,164$2,222 – $2,424
Swedish Medical CenterSeattleFile dated 2026-04-01—$1,164 – $1,253$2,424 – $2,610
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$1,067 – $1,164$2,222 – $2,424
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$447$1,118
University of Washington Medical CtrSeattleFile dated 2026-04-01—$1,412$2,017

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
$877 (fee)