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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Idaho rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $676 · 10th–90th $380$9120%20%40%10th90th$676Professionalmedian $525 · 10th–90th $288$8130%20%10th90th$525$1.0$5.0$20.0$100.0$500.0

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
Professional
Modifier
Global
Typical Low
$354.81
Median
$478.63
Typical High
$616.60
BCBS
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$691.83
Typical High
$1,174.90
BCBS
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$812.83
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$616.60
Typical High
$776.25
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$707.95
Typical High
$741.31
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$630.96
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$707.95
Typical High
$707.95
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$812.83
Select Health
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$741.31
Typical High
$1,122.02
Select Health
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$707.95
Typical High
$812.83
United
Setting
Facility
Modifier
Global
Typical Low
$0.50
Median
$478.63
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$316.23
Typical High
$489.78