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Wyoming rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.11 / $250.11 / $438.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.49 / $488.49 / $488.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.49 / $488.49 / $488.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $577.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.78 / $217.72 / $335.50