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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Indiana 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?

$372

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $372 for this service. The price depends on where it is billed: about $372 from a physician practice, and about $776 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$372$355 to $427
FacilityA hospital or hospital-owned outpatient department$776$457 to $776

How much rates vary

Facilitymedian $776 · 10th to 90th $363 to $813Professionalmedian $372 · 10th to 90th $295 to $575
$200$500$1Kfacility $776professional $372

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$363.08
Typical High
$478.63
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$776.25
Typical High
$954.99
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$691.83
CareSource
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$831.76
Typical High
$954.99
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$977.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$660.69
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$489.78
Typical High
$776.25
United
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$380.19
Typical High
$537.03

Where Indiana 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.

Indiana· 37th of 51

$372

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.