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
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 | $645 – $709 | — | — |
| Deaconess Medical Center | $645 – $709 | — | — |
| Harborview Medical Center | $658 – $724 | $806 | $1,151 |
| Kadlec Regional Medical Center | $658 – $789 | — | — |
| Mary Bridge Children's Hospital | $645 – $709 | — | — |
| MultiCare Auburn Medical Center | $645 – $709 | — | — |
| MultiCare Covington Medical Center | $645 – $709 | — | — |
| MultiCare Good Samaritan Hospital | $645 – $709 | — | — |
| MultiCare Valley Hospital | $664 – $709 | — | — |
| Overlake Hospital Medical Center & Clinics | $658 – $684 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $658 – $789 | — | — |
| Providence Centralia Hospital | $658 – $1,053 | — | — |
| Providence Regional Medical Center Everett | $658 – $724 | — | — |
| Providence St Peter Hospital | $658 – $1,053 | — | — |
| Seattle Children's Hospital | — | $1,849 | $1,849 |
| Swedish Edmonds Hospital | $658 – $789 | — | — |
| Swedish Issaquah | $658 – $789 | — | — |
| Swedish Medical Center | $658 – $789 | — | — |
| Swedish Medical Center / Cherry Hill | $658 – $789 | — | — |
| Tacoma General Allenmore Hospital | $645 – $709 | — | — |
| University of Washington Medical Ctr | $658 – $724 | $1,019 | $1,456 |
| Virginia Mason Medical Center | $451 – $677 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $645 – $722 | — | — |
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)