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North Carolina 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
$2,012.52 / $2,012.52 / $4,084.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,209.61 / $2,012.52 / $2,012.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,167.90 / $2,601.48 / $4,939.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,882.49 / $2,027.96 / $2,027.96
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 / $2,119.51 / $3,530.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.65 / $2,012.52 / $3,180.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,978.61 / $1,978.61 / $1,978.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,350.20 / $3,350.20 / $5,151.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.41 / $1,348.97 / $2,116.30
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,116.62 / $13,723.75 / $13,723.75
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,834.51 / $20,938.88 / $20,938.88