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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Rhode Island rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated October 2026.

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

$398

Typical negotiated rate. In Rhode Island, October 2026.

Insurers have agreed to pay about $398 for this service. The price depends on where it is billed: about $398 from a physician practice, and about $1,318 from a hospital or other facility.

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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$398$355 to $427
FacilityA hospital or hospital-owned outpatient department$1,318$1,047 to $1,514

How much rates vary

Facilitymedian $1,318 · 10th to 90th $851 to $1,660Professionalmedian $398 · 10th to 90th $288 to $589
$500$1Kfacility $1,318professional $398

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$42.66
Median
$42.66
Typical High
$42.66
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$1,047.13
Median
$1,412.54
Typical High
$1,659.59
BCBS Rhode Island
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$398.11
Typical High
$616.60
Cigna
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
United
Setting
Facility
Modifier
None
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
United
Setting
Professional
Modifier
None
Typical Low
$275.42
Median
$416.87
Typical High
$588.84

Where Rhode Island sits

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

Rhode Island· 29th of 51

$398

HI $794DE $288

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.