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Wyoming rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.60 / $62.60 / $109.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.26 / $122.26 / $122.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.26 / $122.26 / $122.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $153.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $124.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.54 / $82.54 / $82.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.45 / $62.46 / $96.25