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Rhode Island 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
$1,239.83 / $1,507.96 / $1,682.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,012.00 / $5,418.73 / $6,415.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.41 / $1,853.42 / $2,566.11
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.50 / $1,620.54 / $2,359.44