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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Minnesota rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $1,288 · 10th–90th $646$6,1660%20%10th90th$1,288Professionalmedian $759 · 10th–90th $501$8710%50%10th90th$759$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
$630.96
Median
$630.96
Typical High
$630.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$512.86
Typical High
$630.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$758.58
Typical High
$1,096.48
BCBS
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$758.58
Typical High
$758.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,659.59
Median
$2,884.03
Typical High
$7,762.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,000.00
Typical High
$1,122.02
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$3,162.28
Typical High
$6,165.95
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,202.26
Medica
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$758.58
Typical High
$3,311.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$316.23
Typical High
$812.83
United
Setting
Facility
Modifier
Global
Typical Low
$5.01
Median
$416.87
Typical High
$1,023.29
United
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$416.87
Typical High
$1,047.13