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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Maine rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $741 · 10th–90th $398$9120%20%10th90th$741Professionalmedian $427 · 10th–90th $302$6310%20%10th90th$427$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$380.19
Typical High
$478.63
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$851.14
Typical High
$954.99
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$724.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$524.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$741.31
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$380.19
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$416.87
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$616.60
Typical High
$630.96