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Below-Knee Prosthesis Protective Cover, Custom-Shaped

West Virginia rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $347 · 10th–90th $347$7240%50%90th$347Professionalmedian $372 · 10th–90th $347$4790%20%10th90th$372$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
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$371.54
CareSource
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$870.96
CareSource
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$776.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$977.24
Typical High
$977.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$3,467.37
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$489.78
United
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$416.87
Typical High
$724.44
United
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$426.58
Typical High
$588.84