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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Texas rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $525 · 10th–90th $282$1,4130%10%20%10th90th$525Professionalmedian $331 · 10th–90th $282$5620%20%40%10th90th$331$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
$281.84
Median
$302.00
Typical High
$524.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$346.74
Typical High
$562.34
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$380.19
Typical High
$489.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$501.19
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$524.81
Typical High
$660.69
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$660.69
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$977.24
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$537.03
Typical High
$870.96
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$616.60
Typical High
$741.31
Molina
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$380.19
Providence
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$501.19
Typical High
$891.25
Providence
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$524.81
Typical High
$724.44
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$389.05
Typical High
$478.63
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$660.69
Typical High
$891.25