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Below-Knee Prosthesis Protective Cover, Custom-Shaped

South Dakota rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $692 · 10th–90th $479$1,3800%10%10th90th$692Professionalmedian $692 · 10th–90th $479$1,0960%20%10th90th$692$200.0$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
Facility
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$512.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$630.96
Typical High
$691.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$831.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$1,096.48
Medica
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$724.44
Typical High
$1,905.46
Medica
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$478.63
Typical High
$3,630.78
Midlands
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$812.83
Typical High
$812.83
Midlands
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Midlands
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$676.08
Typical High
$1,288.25
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$707.95
Typical High
$933.25
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$478.63
Typical High
$524.81
United
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$478.63
Typical High
$891.25
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31