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Washington rates for HCPCS L5703

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

Facilitymedian $2,951 · 10th–90th $1,905–$6,6070%20%10th90th$2,951Professionalmedian $1,995 · 10th–90th $1,230–$4,0740%10%20%10th90th$1,995$1.0$5.0$20.0$100.0$500.0$2.0K$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
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,905.46 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,513.56 / $2,570.40
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,884.03 / $2,884.03
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $3,311.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $2,137.96
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,715.35 / $8,317.64
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,467.37 / $5,754.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $2,238.72 / $2,454.71
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,884.03 / $2,951.21
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,951.21 / $2,951.21
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $4,265.80 / $5,888.44
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $2,454.71 / $2,884.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $2,884.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $3,311.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $4,073.80 / $4,073.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,659.59 / $2,398.83
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,570.40 / $4,466.84