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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Alaska rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $398 · 10th–90th $204$7590%20%40%10th90th$398Professionalmedian $501 · 10th–90th $355$1,0720%20%10th90th$501$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$380.19
Typical High
$676.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$851.14
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$489.78
Typical High
$758.58
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$794.33
Typical High
$2,238.72
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$758.58
Typical High
$794.33
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$758.58
Typical High
$794.33
Providence
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$741.31
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$398.11
Typical High
$691.83
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$478.63
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$389.05
Typical High
$1,513.56