go back

Below-Knee Prosthesis Protective Cover, Custom-Shaped

Ohio rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $776 · 10th–90th $372$1,3180%20%10th90th$776Professionalmedian $380 · 10th–90th $288$7940%20%40%10th90th$380$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
$371.54
Typical High
$630.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$371.54
Typical High
$562.34
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$812.83
Typical High
$1,659.59
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$446.68
Typical High
$977.24
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
CareSource
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$549.54
Typical High
$776.25
CareSource
Setting
Professional
Modifier
Global
Typical Low
$416.87
Median
$575.44
Typical High
$870.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$436.52
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$436.52
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$416.87
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$457.09
Typical High
$660.69
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$870.96
Typical High
$1,584.89
United
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$616.60
Typical High
$776.25
United
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$380.19
Typical High
$501.19