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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Hawaii rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated October 2026.

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

$794

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $794 for this service. Most negotiated rates run $537 to $832.

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.

How much rates vary

Facilitymedian $617 · 10th to 90th $398 to $617Professionalmedian $794 · 10th to 90th $490 to $851
$500$1Kfacility $617professional $794

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Cigna
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$616.60
Typical High
$616.60
Cigna
Setting
Professional
Modifier
None
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
HMSA
Setting
Professional
Modifier
None
Typical Low
$794.33
Median
$794.33
Typical High
$831.76
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$478.63
Median
$794.33
Typical High
$1,023.29
United
Setting
Professional
Modifier
None
Typical Low
$537.03
Median
$851.14
Typical High
$851.14
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$489.78
Median
$489.78
Typical High
$489.78

Where Hawaii sits

The same service costs 2.8 times more in Hawaii than in Delaware. 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.

Hawaii· 1st of 51

$794

HI $794DE $288

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.