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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.

Facilitymedian $724 · 10th–90th $372$8910%20%40%10th90th$724Professionalmedian $380 · 10th–90th $295$6460%50%10th90th$380$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$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