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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 October 2026.

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

$380

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $380 for this service. The price depends on where it is billed: about $380 from a physician practice, and about $776 from a hospital or other facility.

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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$380$380 to $490
FacilityA hospital or hospital-owned outpatient department$776$603 to $776

How much rates vary

Facilitymedian $776 · 10th to 90th $398 to $1,230Professionalmedian $380 · 10th to 90th $339 to $776
$200$500$1K$2Kfacility $776professional $380

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
Aetna
Setting
Professional
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$645.65
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$602.56
Median
$776.25
Typical High
$812.83
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$380.19
Median
$380.19
Typical High
$776.25
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$38.02
Median
$38.02
Typical High
$54.95
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$288.40
Median
$288.40
Typical High
$407.38
CareSource
Setting
Facility
Modifier
None
Typical Low
$933.25
Median
$933.25
Typical High
$954.99
Cigna
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$776.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$398.11
Typical High
$3,467.37
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$912.01
Median
$1,122.02
Typical High
$2,344.23
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$478.63
Median
$630.96
Typical High
$933.25
United
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
United
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$380.19
Typical High
$630.96
4 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$177.83
Median
$177.83
Typical High
$323.59
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$72.44
Median
$72.44
Typical High
$128.82
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$53.70
Median
$53.70
Typical High
$95.50
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$36.31
Median
$36.31
Typical High
$64.57

Where Indiana sits

The same service costs 2.8 times more in Hawaii than in Delaware. 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· 38th of 51

$380

HI $794DE $288

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.