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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 July 2026.

Facilitymedian $1,175 · 10th–90th $417$1,6600%10%20%10th90th$1,175Professionalmedian $398 · 10th–90th $309$4790%20%10th90th$398$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$346.74
Typical High
$426.58
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,412.54
Typical High
$1,659.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$398.11
Typical High
$630.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$416.87
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$489.78
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$407.38
Typical High
$588.84