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Arkansas 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
Facility
Modifier
Low / Median / High Price
$1,778.02 / $1,778.02 / $1,778.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,158.01 / $1,778.02 / $1,778.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,761.55 / $3,654.99 / $4,061.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,510.75 / $2,510.75 / $2,703.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,510.75 / $2,510.75 / $2,510.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $2,559.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $2,119.51 / $2,499.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.82 / $1,595.90 / $2,137.40