HCPCS L5677
Additions to lower extremity, below knee, knee joints, polycentric, pair
Current codeBelow Knee Orthotic24 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 | $567 – $4,399 | — | — |
| Deaconess Medical Center | $787 – $2,738 | — | — |
| Harborview Medical Center | $1,053 – $1,316 | $806 | $1,151 |
| Kadlec Regional Medical Center | $992 – $1,848 | — | — |
| Mary Bridge Children's Hospital | $567 – $4,828 | — | — |
| MultiCare Auburn Medical Center | $551 – $2,842 | — | — |
| MultiCare Covington Medical Center | $551 – $2,842 | — | — |
| MultiCare Good Samaritan Hospital | $640 – $2,842 | — | — |
| MultiCare Valley Hospital | $630 – $2,732 | — | — |
| Overlake Hospital Medical Center & Clinics | $603 – $1,810 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $1,019 – $2,183 | — | — |
| Providence Centralia Hospital | $1,112 – $2,460 | — | — |
| Providence Regional Medical Center Everett | $789 – $1,526 | — | — |
| Providence St Peter Hospital | $559 – $2,148 | — | — |
| Seattle Children's Hospital | $999 – $1,775 | $1,849 | $1,849 |
| Swedish Edmonds Hospital | $987 – $2,413 | — | — |
| Swedish Issaquah | $987 – $1,460 | — | — |
| Swedish Medical Center | $987 – $2,350 | — | — |
| Swedish Medical Center / Cherry Hill | $987 – $2,350 | — | — |
| Tacoma General Allenmore Hospital | $551 – $2,842 | — | — |
| University of Washington Medical Ctr | $1,053 – $2,063 | $1,019 | $1,456 |
| Virginia Mason Medical Center | $630 – $2,288 | — | — |
| Wellfound Behavioral Health Hospital | $1,660 | — | — |
| Yakima Valley Memorial | $567 – $1,707 | — | — |
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
- $658 (fee)