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Oklahoma 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
$1,372.52 / $1,372.52 / $1,372.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.52 / $1,507.96 / $1,568.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.93 / $2,801.07 / $2,801.07
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 / $2,119.51 / $2,119.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.65 / $1,812.16 / $13,256.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.06 / $1,655.22 / $3,131.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,043.82 / $1,442.39 / $1,886.84