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Wyoming rates for HCPCS L5704

Custom shaped protective cover, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.37 / $355.37 / $622.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.07 / $694.07 / $694.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.07 / $694.07 / $694.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $820.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.27 / $288.27 / $394.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.95 / $420.39 / $485.86