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Nebraska 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
$1,610.25 / $1,610.25 / $1,610.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,610.25 / $1,610.25 / $1,898.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,219.26 / $2,441.19 / $2,465.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,777.53 / $2,777.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,119.51 / $2,777.53 / $4,413.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.23 / $2,769.41 / $13,256.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.34 / $1,655.22 / $2,099.51
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,769.41 / $2,777.53 / $3,814.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,314.83 / $3,328.90 / $5,722.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.34 / $1,259.71 / $1,976.26