go back

Below-Knee Prosthesis Protective Cover, Custom-Shaped

Hawaii rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $427 · 10th–90th $398$6170%50%10th90th$427Professionalmedian $794 · 10th–90th $251$8320%50%10th90th$794$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
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