go back

Below-Knee Prosthesis Protective Cover, Custom-Shaped

Mississippi rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $617 · 10th–90th $437$8510%20%10th90th$617Professionalmedian $407 · 10th–90th $282$6460%20%10th90th$407$50.0$100.0$200.0$500.0$1.0K$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
$645.65
Median
$645.65
Typical High
$645.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$407.38
Typical High
$645.65
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$524.81
BCBS
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$616.60
BCBS
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$524.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$446.68
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$524.81
Typical High
$1,023.29
United
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$316.23
Typical High
$489.78