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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.

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

$631

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $631 for this service. The price depends on where it is billed: about $631 from a physician practice, and about $490 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 9 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$631$347 to $631
FacilityA hospital or hospital-owned outpatient department$490$309 to $851

How much rates vary

Facilitymedian $490 · 10th to 90th $309 to $2,951Professionalmedian $631 · 10th to 90th $309 to $955
$100$200$500$1K$2K$5Kfacility $490professional $631

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
$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

Where Massachusetts 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.

Massachusetts· 8th of 51

$631

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.