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Washington, DC 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
$1,338.27 / $1,338.27 / $1,338.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,338.27 / $1,338.27 / $1,338.27
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.20 / $1,346.20 / $1,716.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $1,547.24 / $1,547.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.99 / $1,631.99 / $4,983.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.06 / $1,252.58 / $2,140.90