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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Iowa rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $631 · 10th–90th $398$1,7780%10%20%10th90th$631Professionalmedian $479 · 10th–90th $282$8710%10%20%10th90th$479$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
$371.54
Median
$588.84
Typical High
$630.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$478.63
Typical High
$645.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$831.76
Cigna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$870.96
Typical High
$1,096.48
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$758.58
Typical High
$831.76
Medica
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$954.99
Typical High
$3,311.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$478.63
Typical High
$1,258.93
Midlands
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$870.96
Typical High
$977.24
Midlands
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Midlands
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$1,258.93
Typical High
$1,258.93
United
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$758.58
Typical High
$1,380.38
United
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$416.87
Typical High
$758.58
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$741.31
Typical High
$741.31