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Missouri 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
$1,153.60 / $1,706.39 / $1,761.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,153.60 / $1,507.41 / $2,403.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,525.03 / $2,651.28 / $11,655.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.52 / $1,526.81 / $2,076.90
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 / $2,183.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,153.60 / $2,114.96 / $13,256.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.82 / $1,371.23 / $2,559.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.82 / $1,259.71 / $1,930.19