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Kentucky 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
$1,224.83 / $1,286.83 / $1,338.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.45 / $1,338.30 / $1,623.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,683.21 / $2,703.95 / $2,841.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,264.69 / $1,507.96 / $1,526.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,027.96 / $3,650.33 / $4,872.97
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,588.77 / $3,502.45 / $4,461.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $3,257.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $2,119.51 / $13,653.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.31 / $1,348.97 / $2,087.64