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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.

Facilitymedian $776 · 10th–90th $363$8130%50%10th90th$776Professionalmedian $372 · 10th–90th $295$5750%50%10th90th$372$1.0$5.0$20.0$100.0$500.0$2.0K

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
$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