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Below-Knee Prosthesis Protective Cover, Custom-Shaped

North Dakota rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated October 2026.

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

$676

Typical negotiated rate. In North Dakota, October 2026.

Insurers have agreed to pay about $676 for this service. The price depends on where it is billed: about $676 from a physician practice, and about $513 from a hospital or other facility.

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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$676$513 to $794
FacilityA hospital or hospital-owned outpatient department$513$513 to $631

How much rates vary

Facilitymedian $513 · 10th to 90th $398 to $1,288Professionalmedian $676 · 10th to 90th $316 to $871
$200$500$1K$2Kfacility $513professional $676

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$512.86
Median
$512.86
Typical High
$512.86
Aetna
Setting
Professional
Modifier
None
Typical Low
$380.19
Median
$512.86
Typical High
$630.96
BCBS North Dakota
Setting
Professional
Modifier
None
Typical Low
$602.56
Median
$794.33
Typical High
$794.33
BCBS North Dakota
Setting
Professional
Modifier
22 · Increased work
Typical Low
$724.44
Median
$954.99
Typical High
$954.99
Cigna
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$398.11
Median
$870.96
Typical High
$1,096.48
Medica
Setting
Facility
Modifier
None
Typical Low
$281.84
Median
$512.86
Typical High
$3,311.31
Medica
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$478.63
Typical High
$575.44
United
Setting
Professional
Modifier
None
Typical Low
$245.47
Median
$478.63
Typical High
$575.44

Where North Dakota sits

The same service costs 2.8 times more in Hawaii than in Delaware. 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.

North Dakota· 9th of 51

$676

HI $794DE $288

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.