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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Oregon rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

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

$575

Typical negotiated rate. In Oregon, July 2026.

Insurers have agreed to pay about $575 for this service. The price depends on where it is billed: about $550 from a physician practice, and about $708 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$550$355 to $708
FacilityA hospital or hospital-owned outpatient department$708$575 to $724

How much rates vary

Facilitymedian $708 · 10th to 90th $550 to $724Professionalmedian $550 · 10th to 90th $288 to $813
$100$200$500$1K$2Kfacility $708professional $550

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Oregon sits

The same service costs 2.8 times more in Hawaii than in Nebraska. 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.

Oregon· 12th of 51

$575

HI $794NE $282

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.