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Below-Knee Prosthesis Protective Cover, Custom-Shaped

New York rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $479 · 10th–90th $295$1,0470%20%10th90th$479Professionalmedian $398 · 10th–90th $275$9550%20%10th90th$398$1.0$10.0$100.0$1.0K$10.0K

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
$346.74
Typical High
$776.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$331.13
Typical High
$478.63
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$1,380.38
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$398.11
Typical High
$1,023.29
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$524.81
Median
$562.34
Typical High
$562.34
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$562.34
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$977.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$416.87
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$1,148.15
Typical High
$2,691.53
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$724.44
Typical High
$1,318.26
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$501.19
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$436.52
Typical High
$478.63
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$660.69
Typical High
$776.25
United
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$478.63
Typical High
$1,122.02
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$457.09
Typical High
$1,122.02
Univera
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$426.58
Typical High
$501.19
Univera
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$436.52
Typical High
$478.63