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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Michigan rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $851 · 10th–90th $417$3,0200%20%10th90th$851Professionalmedian $427 · 10th–90th $339$7590%20%10th90th$427$1.0$5.0$20.0$100.0$500.0$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
Facility
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$380.19
Typical High
$426.58
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$2,290.87
Typical High
$4,365.16
BCBS
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$758.58
Typical High
$794.33
CareSource
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$398.11
Typical High
$776.25
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$1,445.44
Typical High
$1,621.81
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$602.56
Typical High
$933.25
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$630.96
Typical High
$776.25
United
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$616.60
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$363.08
Typical High
$512.86