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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 July 2026.

Facilitymedian $513 · 10th–90th $513$8710%50%90th$513Professionalmedian $661 · 10th–90th $380$8710%10%20%10th90th$661$200.0$500.0$1.0K$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
$512.86
Median
$512.86
Typical High
$630.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$512.86
Typical High
$2,818.38
BCBS
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$776.25
Typical High
$851.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$870.96
Typical High
$1,096.48
Medica
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$630.96
Typical High
$1,548.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$354.81
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$1,023.29
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$478.63
Typical High
$891.25