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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Wyoming rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $490 · 10th–90th $417$6920%20%10th90th$490Professionalmedian $603 · 10th–90th $316$6920%20%10th90th$603$200.0$500.0

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
$354.81
Median
$354.81
Typical High
$616.60
BCBS
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
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
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$575.44
United
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$316.23
Typical High
$489.78