go back

Below-Knee Prosthesis Protective Cover, Custom-Shaped

Oregon rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $708 · 10th–90th $550$7240%50%10th90th$708Professionalmedian $550 · 10th–90th $288$8130%10%20%10th90th$550$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
Professional
Modifier
Global
Typical Low
$281.84
Median
$380.19
Typical High
$630.96
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
$288.40
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$1,412.54
Typical High
$1,698.24
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$549.54
Typical High
$741.31
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$588.84
Typical High
$812.83
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$707.95
Typical High
$724.44
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$724.44
Typical High
$724.44
Providence
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$602.56
Typical High
$831.76
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$630.96
Typical High
$758.58
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$758.58
Typical High
$2,884.03
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$812.83
Typical High
$812.83
United
Setting
Facility
Modifier
Global
Typical Low
$0.50
Median
$426.58
Typical High
$1,023.29
United
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$316.23
Typical High
$602.56