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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Florida rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $339 · 10th–90th $275$1,2020%20%10th90th$339Professionalmedian $339 · 10th–90th $275$5370%20%10th90th$339$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
$275.42
Median
$309.03
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$338.84
Typical High
$501.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$489.78
Typical High
$588.84
AvMed
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
AvMed
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$616.60
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$977.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$398.11
Typical High
$660.69
Molina
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$338.84
Typical High
$389.05
United
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$478.63
Typical High
$660.69
United
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$323.59
Typical High
$478.63
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$660.69