go back

Below-Knee Prosthesis Protective Cover, Custom-Shaped

Tennessee rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $490 · 10th–90th $275$3,5480%20%10th90th$490Professionalmedian $309 · 10th–90th $275$5370%50%10th90th$309$1.0$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$489.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$309.03
Typical High
$537.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$562.34
Typical High
$588.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$524.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$3,548.13
Typical High
$3,548.13
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$3,715.35
Median
$5,128.61
Typical High
$5,128.61
United
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$478.63
Typical High
$660.69
United
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$316.23
Typical High
$478.63