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Wyoming rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.10 / $200.10 / $350.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.81 / $390.81 / $390.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.81 / $390.81 / $390.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $468.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $306.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.48 / $264.77 / $306.01