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Kansas 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
$1,898.65 / $1,898.65 / $1,898.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.65 / $1,321.85 / $2,114.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,811.56 / $1,976.49 / $2,096.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.83 / $1,961.83 / $1,961.83
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 / $4,413.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.65 / $2,034.96 / $13,256.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.06 / $1,445.76 / $3,225.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.80 / $1,259.71 / $1,930.19