go back

Below-Knee Prosthesis Protective Cover, Custom-Shaped

Arizona rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

How much does Below-Knee Prosthesis Protective Cover, Custom-Shaped cost?

$380

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $380 for this service. The price depends on where it is billed: about $355 from a physician practice, and about $631 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$355$288 to $479
FacilityA hospital or hospital-owned outpatient department$631$363 to $977

How much rates vary

Facilitymedian $631 · 10th to 90th $204 to $1,549Professionalmedian $355 · 10th to 90th $275 to $794
$200$500$1K$2Kfacility $631professional $355

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$354.81
Typical High
$707.95
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
BCBS
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$831.76
Typical High
$1,584.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$776.25
Typical High
$1,548.82
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
$398.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$501.19
Typical High
$3,311.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$316.23
Typical High
$3,630.78
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$602.56
Typical High
$741.31
United
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$316.23
Typical High
$478.63

Where Arizona sits

The same service costs 2.8 times more in Hawaii than in Nebraska. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Arizona· 32nd of 51

$380

HI $794NE $282

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.