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HCPCS L5704

Custom shaped protective cover, below knee

Current codeBelow Knee Orthotic24 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Other government program: TRICARE, VA, Indian Health Service, workers' compensation, or another public program.

HospitalOther government program rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27—$380$951
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$380$951
Harborview Medical CenterSeattleFile dated 2026-04-01—$903 – $915$1,289 – $1,306
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$380$951
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$380$951
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$380$951
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$380$951
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$380$951
Seattle Children's HospitalSeattle$8621 plan$2,102$2,102
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$380$951
University of Washington Medical CtrSeattleFile dated 2026-04-01—$1,281$1,829

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

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)