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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.

How much does Below-Knee Prosthesis Protective Cover, Custom-Shaped cost?

$513

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $513 for this service. The price depends on where it is billed: about $479 from a physician practice, and about $631 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$479$372 to $631
FacilityA hospital or hospital-owned outpatient department$631$513 to $1,000

How much rates vary

Facilitymedian $631 · 10th to 90th $398 to $1,778Professionalmedian $479 · 10th to 90th $282 to $871
$200$500$1K$2Kfacility $631professional $479

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Iowa sits

The same service costs 2.8 times more in Hawaii than in Nebraska. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Iowa· 14th of 51

$513

HI $794NE $282

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.