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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Virginia 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?

$380

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $380 for this service. The price depends on where it is billed: about $380 from a physician practice, and about $724 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 8 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$380$372 to $468
FacilityA hospital or hospital-owned outpatient department$724$468 to $724

How much rates vary

Facilitymedian $724 · 10th to 90th $372 to $891Professionalmedian $380 · 10th to 90th $295 to $646
$200$500$1K$2K$5K$10Kfacility $724professional $380

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$371.54
Typical High
$389.05
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$758.58
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$794.33
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$489.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$724.44
Typical High
$1,000.00
Medcost
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$467.74
Typical High
$707.95
Medcost
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$478.63
Typical High
$831.76
Medcost
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$407.38
Typical High
$467.74
Sentara
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$588.84
Typical High
$1,548.82
Sentara
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$588.84
Typical High
$1,548.82
United
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$467.74
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$354.81
Typical High
$549.54

Where Virginia 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.

Virginia· 31st of 51

$380

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.