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Ohio 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
$1,487.12 / $1,487.12 / $3,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,231.16 / $1,487.12 / $1,760.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,859.83 / $3,350.17 / $8,679.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.74 / $1,526.81 / $3,959.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,027.96 / $3,045.61 / $4,111.57
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,979.65 / $2,741.05 / $6,521.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $3,257.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $1,547.24 / $2,532.37
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $2,119.51
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $2,119.51 / $2,119.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,494.50 / $2,135.00 / $3,078.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,012.95 / $1,519.42 / $1,933.25