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Below-Knee Prosthesis Protective Cover, Custom-Shaped

New Hampshire rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $724 · 10th–90th $398$8910%20%40%10th90th$724Professionalmedian $479 · 10th–90th $309$6310%20%10th90th$479$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
$398.11
Median
$398.11
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$398.11
Typical High
$478.63
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$776.25
Typical High
$891.25
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$524.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$1,148.15
United
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$446.68
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$478.63
Typical High
$630.96
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$1,023.29