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Wyoming rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.50 / $52.50 / $91.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.53 / $102.53 / $102.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.53 / $102.53 / $102.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $105.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $60.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.45 / $64.09 / $74.06