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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Oklahoma rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $347 · 10th–90th $275$7760%20%10th90th$347Professionalmedian $355 · 10th–90th $263$5620%10%20%10th90th$355$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
$275.42
Median
$275.42
Typical High
$316.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$316.23
Typical High
$380.19
BCBS
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
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$812.83
Medica
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$407.38
Typical High
$1,995.26
Medica
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$354.81
Typical High
$794.33
United
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$524.81
Typical High
$724.44
United
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$309.03
Typical High
$478.63