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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.

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

$692

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $692 for this service. The price depends on where it is billed: about $692 from a physician practice, and about $692 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 7 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$692$617 to $871
FacilityA hospital or hospital-owned outpatient department$692$513 to $871

How much rates vary

Facilitymedian $692 · 10th to 90th $479 to $1,380Professionalmedian $692 · 10th to 90th $479 to $1,096
$500$1K$2Kfacility $692professional $692

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where South Dakota 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.

South Dakota· 5th of 51

$692

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.