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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Illinois rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $776 · 10th–90th $372$3,8900%20%10th90th$776Professionalmedian $575 · 10th–90th $302$7760%20%10th90th$575$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$371.54
Median
$371.54
Typical High
$776.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$371.54
Typical High
$776.25
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$562.34
Typical High
$575.44
BCBS
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$1,479.11
Typical High
$5,248.07
BCBS
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$588.84
Typical High
$588.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$831.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$758.58
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$776.25
Typical High
$977.24
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
Molina
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$602.56
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$616.60
Typical High
$776.25
United
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$380.19
Typical High
$630.96