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Below-Knee Prosthesis Protective Cover, Custom-Shaped

South Carolina rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $427 · 10th–90th $288$8510%20%10th90th$427Professionalmedian $339 · 10th–90th $288$4790%20%10th90th$339$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
$288.40
Median
$288.40
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$331.13
Typical High
$478.63
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
BCBS
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$588.84
Typical High
$660.69
BCBS
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$562.34
Typical High
$812.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$398.11
Typical High
$436.52
Cigna
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$870.96
Medcost
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$323.59
Typical High
$426.58
Medcost
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$524.81
Typical High
$1,071.52
Medcost
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Molina
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$478.63
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$323.59
Typical High
$478.63