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Montana rates for HCPCS L5703

Ankle, Symes, molded to patient model, socket without solid ankle cushion heel (SACH) foot, replacement only

Facilitymedian $2,630 · 10th–90th $1,995–$3,7150%20%10th90th$2,630Professionalmedian $1,905 · 10th–90th $933–$3,3110%10%20%10th90th$1,905$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,778.28 / $2,818.38
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,630.27 / $2,630.27 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,884.03 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,884.03 / $2,884.03
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,630.27 / $5,128.61
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,630.27 / $5,128.61
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,511.89 / $3,890.45
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $2,137.96 / $2,884.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,905.46 / $1,995.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,258.93 / $1,949.84