Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Replacement Custom Shape Protect Cover L5704
Low
$301
Average
$991
Median
$681
High
$3.7k
Filter by billing methodology
Prices here combine facility and professional fees. See them separately →Experimental
Reflects a negotiated percentage of total billed charges.
Showing only prices reported under the percent of billed charges methodology. Choose another in the filter above to change the chart. 42 hospitals; the 90th percentile is 3.5× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Children's Healthcare of Atlanta Atlanta, GA | $1.4k | $1.5k | $222 | 15% | — | $1.3k – $2.0k |
| 2 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL | $847 | $798 | $168 | 21% | — | $180 – $1.0k |
| 3 | Allina Health Systems Shakopee, MN | $1.8k | $1.6k | $468 | 29% | — | $473 – $2.4k |
| 4 | University of Iowa Health Care Medical Center Iowa City, IA | $1.5k | $1.5k | $431 | 28% | — | $585 – $2.2k |
| 5 | Hmh Hospitals Corporation Hackensack, NJ | $598 | $585 | $182 | 31% | — | $156 – $846 |
| 6 | MultiCare Auburn Medical Center Auburn, WA | $694 | $668 | $53 | 8% | — | $561 – $694 |
| 7 | Hmh Hospitals Corporation Red Bank, NJ | $434 | $466 | $165 | 36% | — | $156 – $737 |
| 8 | MultiCare Capital Medical Center Olympia, WA | $785 | $768 | $47 | 6% | — | $694 – $808 |
| 9 | Allina Health Systems St Paul, MN | $1.7k | $1.6k | $528 | 34% | — | $473 – $2.4k |
| 10 | Tacoma General Allenmore Hospital Tacoma, WA | $694 | $668 | $53 | 8% | — | $561 – $694 |
Ask Claude or any MCP client for HCPCS L5704 pricing at a specific hospital — see how to connect.