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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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,403.40 / $8,336.08 / $8,336.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,651.96 / $2,651.96 / $2,651.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,851.39 / $2,851.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,119.51 / $2,851.39 / $2,851.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,399.80 / $2,715.61 / $2,851.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,119.51 / $2,183.10 / $2,853.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.09 / $1,252.58 / $1,930.19