go back

Below-Knee Prosthesis Protective Cover, Custom-Shaped

Louisiana rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated July 2026.

Facilitymedian $525 · 10th–90th $372$1,1480%20%10th90th$525Professionalmedian $372 · 10th–90th $269$5370%20%10th90th$372$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
$524.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$371.54
Typical High
$537.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
BCBS
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$954.99
Typical High
$1,318.26
BCBS
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$457.09
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
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
$630.96
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$524.81
Typical High
$851.14
United
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$323.59
Typical High
$478.63