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Below-Knee Prosthesis Protective Cover, Custom-Shaped

California rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $363 · 10th–90th $288$1,6600%20%10th90th$363Professionalmedian $380 · 10th–90th $282$3,1620%20%10th90th$380$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
Facility
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$3,162.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$380.19
Typical High
$3,162.28
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$363.08
Typical High
$1,548.82
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$851.14
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$1,148.15
Typical High
$1,778.28
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$691.83
Typical High
$1,905.46
Cigna
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$323.59
Typical High
$891.25
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$676.08
Typical High
$1,148.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$3,548.13
Typical High
$3,548.13
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$5,128.61
Typical High
$5,128.61
Molina
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$933.25
Typical High
$933.25
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$645.65
Typical High
$933.25
Providence
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$707.95
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$354.81
Typical High
$676.08
United
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$416.87
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$380.19
Typical High
$776.25