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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Missouri rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $603 · 10th–90th $339$1,4130%20%10th90th$603Professionalmedian $398 · 10th–90th $288$8910%20%10th90th$398$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
$338.84
Median
$501.19
Typical High
$501.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$501.19
Typical High
$3,162.28
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$575.44
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$2,691.53
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$691.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$758.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$588.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$588.84
Typical High
$1,659.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$371.54
Typical High
$3,630.78
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$602.56
Typical High
$758.58
United
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$371.54
Typical High
$562.34