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Wyoming 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
$1,230.27 / $1,548.82 / $2,818.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $2,630.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $2,630.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,659.59 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,258.93 / $1,949.84