go back

Maine 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
$1,239.83 / $1,911.15 / $1,911.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,523.79 / $3,269.80 / $6,061.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,526.81 / $1,602.21 / $2,130.37
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,297.51 / $2,297.51 / $2,297.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,597.78 / $1,911.15 / $1,911.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.10 / $1,415.66 / $3,929.15