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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 July 2026.

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

$603

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $603 for this service. The price depends on where it is billed: about $589 from a physician practice, and about $692 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$589$398 to $692
FacilityA hospital or hospital-owned outpatient department$692$550 to $741

How much rates vary

Facilitymedian $692 · 10th to 90th $468 to $871Professionalmedian $589 · 10th to 90th $204 to $1,349
$100$200$500$1K$2Kfacility $692professional $589

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$537.03
Typical High
$3,162.28
BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$741.31
Typical High
$741.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$741.31
Typical High
$741.31
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$691.83
Typical High
$1,348.96
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$691.83
Typical High
$1,348.96
Providence
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$660.69
Typical High
$912.01
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$562.34
Typical High
$741.31
United
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$478.63
Typical High
$501.19
United
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$316.23
Typical High
$489.78

Where Montana sits

The same service costs 2.8 times more in Hawaii than in Nebraska. 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· 9th of 51

$603

HI $794NE $282

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.