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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Massachusetts rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $490 · 10th–90th $309$2,9510%10%20%10th90th$490Professionalmedian $631 · 10th–90th $309$9550%20%10th90th$631$1.0$10.0$100.0$1.0K$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
$309.03
Median
$309.03
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$346.74
Typical High
$977.24
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$691.83
Typical High
$3,548.13
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$588.84
Typical High
$870.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$1,258.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$416.87
Typical High
$501.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$446.68
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$933.25
Health New England
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$512.86
Health New England
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$512.86
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$691.83
Typical High
$3,548.13
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$588.84
Typical High
$870.96
United
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$489.78
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$575.44
Typical High
$630.96