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Below-Knee Prosthesis Protective Cover, Custom-Shaped

Tennessee 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?

$372

Typical negotiated rate. In Tennessee, October 2026.

Insurers have agreed to pay about $372 for this service. The price depends on where it is billed: about $347 from a physician practice, and about $398 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$347$288 to $490
FacilityA hospital or hospital-owned outpatient department$398$398 to $398

How much rates vary

Facilitymedian $398 · 10th to 90th $363 to $417Professionalmedian $347 · 10th to 90th $275 to $3,715
$200$500$1K$2K$5Kfacility $398professional $347

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
$281.84
Median
$281.84
Typical High
$281.84
Aetna
Setting
Professional
Modifier
None
Typical Low
$275.42
Median
$281.84
Typical High
$371.54
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$54.95
Median
$56.23
Typical High
$74.13
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$40.74
Median
$41.69
Typical High
$56.23
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$27.54
Median
$28.18
Typical High
$37.15
BCBS Tennessee
Setting
Professional
Modifier
None
Typical Low
$380.19
Median
$489.78
Typical High
$489.78
Cigna
Setting
Facility
Modifier
None
Typical Low
$398.11
Median
$398.11
Typical High
$416.87
Cigna
Setting
Professional
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$398.11
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$3,715.35
Median
$5,248.07
Typical High
$5,248.07
United
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
United
Setting
Professional
Modifier
None
Typical Low
$213.80
Median
$316.23
Typical High
$478.63

Where Tennessee 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.

Tennessee· 43rd of 51

$372

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.