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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Washington, DC rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $372 · 10th–90th $372$1,0230%50%90th$372Professionalmedian $372 · 10th–90th $331$3800%20%40%10th90th$372$200.0$500.0$1.0K

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$371.54
Typical High
$371.54
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$489.78
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
$416.87
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$616.60
Typical High
$1,412.54
United
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,023.29
Typical High
$1,023.29
United
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$371.54
Typical High
$549.54