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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Georgia rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $661 · 10th–90th $269$2,3990%10%20%10th90th$661Professionalmedian $389 · 10th–90th $269$6460%20%10th90th$389$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
$269.15
Median
$269.15
Typical High
$794.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$346.74
Typical High
$537.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$1,548.82
Typical High
$2,398.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$537.03
Typical High
$851.14
CareSource
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
CareSource
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$977.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$870.96
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$660.69
Typical High
$891.25
United
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$478.63
Typical High
$660.69
United
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$323.59
Typical High
$630.96