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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 July 2026.

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

$794

Typical negotiated rate. In Hawaii, July 2026.

Insurers have agreed to pay about $794 for this service. Most negotiated rates run $479 to $794.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $427 · 10th to 90th $398 to $617Professionalmedian $794 · 10th to 90th $251 to $832
$500$1Kfacility $427professional $794

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. 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
Global
Typical Low
$251.19
Median
$251.19
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$616.60
Cigna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$724.44
Typical High
$977.24
HMSA
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$831.76
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$794.33
Typical High
$1,096.48
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$426.58
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$524.81
Typical High
$977.24

Where Hawaii sits

The same service costs 2.8 times more in Hawaii than in Nebraska. 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 $794NE $282

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.