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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Maryland rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $479 · 10th–90th $282$7240%20%40%10th90th$479Professionalmedian $372 · 10th–90th $288$5010%20%40%10th90th$372$200.0$500.0$1.0K$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
Professional
Modifier
Global
Typical Low
$288.40
Median
$371.54
Typical High
$478.63
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$489.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$724.44
Typical High
$1,071.52
United
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$478.63
Typical High
$724.44
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$380.19
Typical High
$562.34
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$616.60