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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Montana 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?

$724

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $724 for this service. The price depends on where it is billed: about $692 from a physician practice, and about $741 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$692$380 to $741
FacilityA hospital or hospital-owned outpatient department$741$724 to $41,687

How much rates vary

Facilitymedian $741 · 10th to 90th $468 to $41,687Professionalmedian $692 · 10th to 90th $79 to $794
$100$500$2K$10K$50Kfacility $741professional $692

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
Professional
Modifier
None
Typical Low
$204.17
Median
$537.03
Typical High
$616.60
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Cigna
Setting
Facility
Modifier
None
Typical Low
$436.52
Median
$741.31
Typical High
$741.31
Cigna
Setting
Professional
Modifier
None
Typical Low
$602.56
Median
$741.31
Typical High
$741.31
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$549.54
Median
$912.01
Typical High
$42,657.95
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$724.44
Median
$794.33
Typical High
$44,668.36
Providence
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$741.31
Typical High
$741.31
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$562.34
Typical High
$741.31
United
Setting
Professional
Modifier
None
Typical Low
$302.00
Median
$316.23
Typical High
$524.81

Where Montana 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.

Montana· 6th of 51

$724

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.