HCPCS L5704
Custom shaped protective cover, below knee
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 | $732 – $805 | $380 | $951 |
| Deaconess Medical Center | $732 – $805 | $380 | $951 |
| Harborview Medical Center | $747 – $821 | $903 – $915 | $1,289 – $1,306 |
| Kadlec Regional Medical Center | $747 – $896 | — | — |
| Mary Bridge Children's Hospital | $732 – $805 | $380 | $951 |
| MultiCare Auburn Medical Center | $732 – $805 | $380 | $951 |
| MultiCare Covington Medical Center | $732 – $805 | $380 | $951 |
| MultiCare Good Samaritan Hospital | $732 – $805 | $380 | $951 |
| MultiCare Valley Hospital | $754 – $805 | $380 | $951 |
| Overlake Hospital Medical Center & Clinics | $747 – $776 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $747 – $896 | — | — |
| Providence Centralia Hospital | $747 – $1,194 | — | — |
| Providence Regional Medical Center Everett | $747 – $821 | — | — |
| Providence St Peter Hospital | $747 – $1,194 | — | — |
| Seattle Children's Hospital | — | $2,102 | $2,102 |
| Swedish Edmonds Hospital | $747 – $896 | — | — |
| Swedish Issaquah | $747 – $896 | — | — |
| Swedish Medical Center | $747 – $896 | — | — |
| Swedish Medical Center / Cherry Hill | $747 – $896 | — | — |
| Tacoma General Allenmore Hospital | $732 – $805 | $380 | $951 |
| University of Washington Medical Ctr | $747 – $821 | $1,281 | $1,829 |
| Virginia Mason Medical Center | $512 – $769 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $732 – $819 | — | — |
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)