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Wyoming rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.17 / $78.17 / $136.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.66 / $152.66 / $152.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.66 / $152.66 / $152.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $169.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $73.02 / $100.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.28 / $91.89 / $106.19