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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Nebraska rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $759 · 10th–90th $417$1,5490%20%10th90th$759Professionalmedian $282 · 10th–90th $269$5620%20%40%10th90th$282$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
$478.63
Median
$478.63
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$281.84
Typical High
$478.63
BCBS
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$724.44
Typical High
$724.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$831.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$870.96
Typical High
$1,584.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$812.83
Typical High
$3,311.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$416.87
Typical High
$741.31
Midlands
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$1,995.26
Midlands
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,862.09
Typical High
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$602.56
Typical High
$758.58
United
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$416.87
Typical High
$588.84