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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Washington rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $724 · 10th–90th $479$1,5490%20%10th90th$724Professionalmedian $603 · 10th–90th $316$1,2590%10%10th90th$603$10.0$50.0$200.0$1.0K$5.0K

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
$478.63
Median
$478.63
Typical High
$1,122.02
Aetna
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$478.63
Typical High
$3,162.28
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$707.95
Typical High
$724.44
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
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
Facility
Modifier
Global
Typical Low
$436.52
Median
$933.25
Typical High
$2,089.30
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$831.76
Typical High
$1,479.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$562.34
Typical High
$616.60
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$707.95
Typical High
$724.44
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$724.44
Typical High
$724.44
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$1,071.52
Typical High
$1,479.11
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$707.95
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$724.44
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$630.96
Typical High
$812.83
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$1,023.29
Typical High
$1,023.29
United
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$457.09
Typical High
$616.60
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$630.96
Typical High
$1,122.02