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Idaho 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
$1,288.25 / $1,778.28 / $2,454.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,818.38 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,311.31 / $3,311.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,137.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $2,454.71 / $6,456.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,818.38 / $3,019.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $2,570.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $2,884.03 / $2,884.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $3,311.31
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,019.95 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,862.09 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,258.93 / $1,949.84