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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Vermont rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $417 · 10th–90th $363$5250%20%40%10th90th$417Professionalmedian $398 · 10th–90th $347$5620%20%10th90th$398$200.0$500.0$1.0K$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$426.58
BCBS
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$575.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$524.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$691.83
United
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$478.63
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$478.63
Typical High
$1,445.44