go back

Below-Knee Prosthesis Protective Cover, Custom-Shaped

Louisiana rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Rates data updated October 2026.

How much does Below-Knee Prosthesis Protective Cover, Custom-Shaped cost?

$398

Typical negotiated rate. In Louisiana, October 2026.

Insurers have agreed to pay about $398 for this service. The price depends on where it is billed: about $372 from a physician practice, and about $851 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$372$288 to $468
FacilityA hospital or hospital-owned outpatient department$851$525 to $1,047

How much rates vary

Facilitymedian $851 · 10th to 90th $398 to $1,288Professionalmedian $372 · 10th to 90th $282 to $525
$200$500$1Kfacility $851professional $372

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$346.74
Median
$346.74
Typical High
$524.81
Aetna
Setting
Professional
Modifier
None
Typical Low
$346.74
Median
$371.54
Typical High
$537.03
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$173.78
Median
$186.21
Typical High
$269.15
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$69.18
Median
$74.13
Typical High
$107.15
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$52.48
Median
$54.95
Typical High
$79.43
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$34.67
Median
$37.15
Typical High
$53.70
Ambetter
Setting
Professional
Modifier
None
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
BCBS Louisiana
Setting
Facility
Modifier
None
Typical Low
$562.34
Median
$977.24
Typical High
$1,380.38
BCBS Louisiana
Setting
Professional
Modifier
None
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
Christus
Setting
Facility
Modifier
None
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
United
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$851.14
Typical High
$851.14
United
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$302.00
Typical High
$478.63

Where Louisiana sits

The same service costs 2.8 times more in Hawaii than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Louisiana· 28th of 51

$398

HI $794DE $288

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.