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Massachusetts 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
$1,239.83 / $1,239.83 / $1,239.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,239.83 / $1,239.83 / $1,970.76
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,538.85 / $7,578.47 / $13,723.75
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,252.58 / $2,046.11 / $2,771.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,098.37 / $3,664.26 / $4,718.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,858.11 / $2,517.76 / $2,517.76
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 / $3,530.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,297.51 / $2,297.51 / $2,412.39
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,945.75 / $1,945.75 / $1,945.75
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,182.59 / $13,723.75 / $13,723.75
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,108.45 / $1,516.82 / $2,771.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,252.58 / $1,680.93 / $2,771.12