HCPCS L5704
Custom shaped protective cover, below knee
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 | $643 – $4,992 | $380 | $951 |
| Deaconess Medical Center | $353 – $3,107 | $380 | $951 |
| Harborview Medical Center | $1,194 – $1,493 | $903 – $915 | $1,289 – $1,306 |
| Kadlec Regional Medical Center | $1,126 – $2,097 | — | — |
| Mary Bridge Children's Hospital | $614 – $5,479 | $380 | $951 |
| MultiCare Auburn Medical Center | $625 – $3,225 | $380 | $951 |
| MultiCare Covington Medical Center | $625 – $3,225 | $380 | $951 |
| MultiCare Good Samaritan Hospital | $625 – $3,225 | $380 | $951 |
| MultiCare Valley Hospital | $353 – $3,100 | $380 | $951 |
| Overlake Hospital Medical Center & Clinics | $685 – $2,054 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $1,156 – $2,477 | — | — |
| Providence Centralia Hospital | $1,262 – $2,791 | — | — |
| Providence Regional Medical Center Everett | $896 – $1,732 | — | — |
| Providence St Peter Hospital | $635 – $2,437 | — | — |
| Seattle Children's Hospital | $1,135 – $2,018 | $2,102 | $2,102 |
| Swedish Edmonds Hospital | $1,120 – $2,739 | — | — |
| Swedish Issaquah | $1,120 – $1,657 | — | — |
| Swedish Medical Center | $1,120 – $2,666 | — | — |
| Swedish Medical Center / Cherry Hill | $1,120 – $2,666 | — | — |
| Tacoma General Allenmore Hospital | $625 – $3,225 | $380 | $951 |
| University of Washington Medical Ctr | $1,194 – $2,341 | $1,281 | $1,829 |
| Virginia Mason Medical Center | $715 – $2,596 | — | — |
| Wellfound Behavioral Health Hospital | $1,884 | — | — |
| Yakima Valley Memorial | $643 – $1,937 | — | — |
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
- $747 (fee)