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Wyoming rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.04 / $111.04 / $194.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.86 / $216.86 / $216.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.86 / $216.86 / $216.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $260.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $101.29 / $138.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.13 / $110.79 / $170.72