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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Wisconsin rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $776 · 10th–90th $589$1,4130%20%40%10th90th$776Professionalmedian $724 · 10th–90th $380$1,2300%20%10th90th$724$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
$380.19
Median
$380.19
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$645.65
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$1,258.93
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$724.44
Typical High
$851.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$1,778.28
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$1,122.02
Typical High
$1,445.44
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$616.60
Typical High
$954.99
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$912.01
Typical High
$1,122.02
Medica
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$758.58
Typical High
$3,311.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$457.09
Typical High
$851.14
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$436.52
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,230.27
Network Health
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$870.96
Typical High
$1,513.56
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$616.60
Typical High
$954.99
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$724.44
Typical High
$758.58
Quartz
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,148.15
Typical High
$1,905.46
Quartz
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$1,548.82
Typical High
$3,388.44
Quartz
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$1,148.15
Typical High
$3,715.35
Security Health
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$691.83
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$478.63
Typical High
$776.25
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$380.19
Typical High
$691.83