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North Dakota 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
$1,975.72 / $1,975.72 / $1,975.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,975.72 / $2,551.00 / $2,551.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,539.09 / $3,002.11 / $3,076.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,530.63 / $3,565.93 / $4,483.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.91 / $1,975.72 / $13,256.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.85 / $1,878.88 / $2,196.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$980.76 / $2,085.92 / $3,197.89