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Below-Knee Prosthesis Protective Cover, Custom-Shaped

North Carolina rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $513 · 10th–90th $295$1,2590%20%10th90th$513Professionalmedian $479 · 10th–90th $288$4900%50%10th90th$479$1.0$10.0$100.0$1.0K$10.0K

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
$478.63
Median
$478.63
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$478.63
Typical High
$478.63
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
BCBS
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$954.99
Typical High
$1,288.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$398.11
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$416.87
Medcost
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$323.59
Typical High
$467.74
Medcost
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$537.03
Typical High
$933.25
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$501.19
Typical High
$660.69
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$323.59
Typical High
$489.78
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$3,388.44
Median
$3,388.44
Typical High
$3,388.44
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$5,128.61