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Alaska rates for HCPCS L5703

Ankle, Symes, molded to patient model, socket without solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,505.62 / $2,505.62 / $2,505.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $2,119.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $2,119.51 / $2,183.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.65 / $808.65 / $808.65
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,718.30 / $2,793.91 / $4,292.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.65 / $808.65 / $2,119.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $2,183.10 / $3,353.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,382.97 / $1,427.51 / $2,736.06