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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.

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

$437

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $437 for this service. The price depends on where it is billed: about $427 from a physician practice, and about $741 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 6 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$427$380 to $631
FacilityA hospital or hospital-owned outpatient department$741$501 to $851

How much rates vary

Facilitymedian $741 · 10th to 90th $398 to $912Professionalmedian $427 · 10th to 90th $302 to $631
$200$500$1Kfacility $741professional $427

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Maine 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.

Maine· 20th of 51

$437

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.