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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 October 2026.

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

$339

Typical negotiated rate. In New Jersey, October 2026.

Insurers have agreed to pay about $339 for this service. The price depends on where it is billed: about $339 from a physician practice, and about $398 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$339$288 to $692
FacilityA hospital or hospital-owned outpatient department$398$363 to $398

How much rates vary

Facilitymedian $398 · 10th to 90th $269 to $692Professionalmedian $339 · 10th to 90th $251 to $692
$500$1Kfacility $398professional $339

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
$251.19
Median
$251.19
Typical High
$269.15
Aetna
Setting
Professional
Modifier
None
Typical Low
$251.19
Median
$251.19
Typical High
$316.23
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$125.89
Median
$125.89
Typical High
$158.49
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$50.12
Median
$50.12
Typical High
$63.10
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$38.02
Median
$38.02
Typical High
$46.77
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$25.12
Median
$25.12
Typical High
$31.62
Cigna
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$691.83
Cigna
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$457.09
Median
$912.01
Typical High
$912.01
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
United
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$851.14
United
Setting
Professional
Modifier
None
Typical Low
$316.23
Median
$380.19
Typical High
$676.08

Where New Jersey 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.

New Jersey· 50th of 51

$339

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.