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Below-Knee Prosthesis Protective Cover, Custom-Shaped

New Jersey rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $251 · 10th–90th $251$6920%50%90th$251Professionalmedian $339 · 10th–90th $257$6760%10%10th90th$339$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
$251.19
Median
$251.19
Typical High
$251.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$331.13
Typical High
$588.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$398.11
Typical High
$691.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$660.69
Typical High
$912.01
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$676.08
Typical High
$676.08
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$691.83
Typical High
$691.83
United
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$416.87
Typical High
$676.08