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Wyoming rates for HCPCS L5694

Addition to lower extremity, above knee (AK), pelvic control belt, padded and lined

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.37 / $121.37 / $212.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.05 / $237.05 / $237.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.05 / $237.05 / $237.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $239.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $216.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.18 / $108.63 / $167.39