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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Arizona rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $631 · 10th–90th $204$1,5490%10%10th90th$631Professionalmedian $355 · 10th–90th $275$7940%20%10th90th$355$1.0$5.0$20.0$100.0$500.0$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
$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