go back

Louisiana 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
$1,728.89 / $1,835.28 / $2,606.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,324.17 / $1,835.28 / $2,659.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,784.31 / $4,756.57 / $6,686.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.79 / $2,271.21 / $2,271.21
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $2,119.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.06 / $1,594.04 / $2,137.40