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Arizona 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
$1,209.61 / $1,300.14 / $2,012.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.52 / $2,740.15 / $4,954.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,896.31 / $2,528.41 / $3,444.96
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 / $1,547.24 / $3,530.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.65 / $1,507.41 / $13,256.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.09 / $1,252.58 / $1,930.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,158.10 / $1,252.58 / $1,886.84