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Indiana 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
$1,449.43 / $1,449.43 / $3,045.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.14 / $1,449.43 / $1,507.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,406.03 / $2,725.82 / $3,045.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.74 / $1,526.81 / $2,106.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,284.21 / $3,350.17 / $4,263.85
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,588.77 / $3,350.17 / $4,111.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $3,045.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $2,119.51 / $2,777.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.06 / $1,519.42 / $2,133.31