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Wyoming rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.90 / $111.90 / $195.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.54 / $218.54 / $218.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.54 / $218.54 / $218.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $246.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $222.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.91 / $148.86 / $172.04