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Maryland 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
Professional
Modifier
Low / Median / High Price
$1,126.39 / $1,239.83 / $2,012.52
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.20 / $1,407.04 / $1,716.33
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 / $1,547.24 / $2,119.51
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.53 / $2,510.75 / $3,615.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.33 / $1,277.64 / $1,961.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,519.27 / $1,519.27 / $1,757.53