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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Pennsylvania rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $851 · 10th–90th $316$3,3110%20%10th90th$851Professionalmedian $347 · 10th–90th $275$5890%20%40%10th90th$347$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
$316.23
Median
$316.23
Typical High
$1,230.27
Aetna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$346.74
Typical High
$562.34
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$575.44
Typical High
$724.44
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
$398.11
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$912.01
Typical High
$1,318.26
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$724.44
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$489.78
Typical High
$724.44
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$1,230.27
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$346.74
Typical High
$562.34
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$2,454.71
Typical High
$3,981.07
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$676.08
Typical High
$724.44
United
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$851.14
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$389.05
Typical High
$724.44