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 | $761 – $808 | $380 | $951 |
| Deaconess Medical Center | $675 – $694 | $380 | $951 |
| Harborview Medical Center | — | $903 – $915 | $1,289 – $1,306 |
| Mary Bridge Children's Hospital | $622 – $761 | $380 | $951 |
| MultiCare Auburn Medical Center | $561 – $694 | $380 | $951 |
| MultiCare Covington Medical Center | $561 – $694 | $380 | $951 |
| MultiCare Good Samaritan Hospital | $561 – $694 | $380 | $951 |
| MultiCare Valley Hospital | $685 | $380 | $951 |
| Seattle Children's Hospital | $1,135 – $2,018 | $2,102 | $2,102 |
| Tacoma General Allenmore Hospital | $561 – $694 | $380 | $951 |
| University of Washington Medical Ctr | — | $1,281 | $1,829 |
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)