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New Hampshire rates for HCPCS L5703

Ankle, Symes, molded to patient model, socket without solid ankle cushion heel (SACH) foot, replacement only

Facilitymedian $2,884 · 10th–90th $1,585–$3,4670%20%40%10th90th$2,884Professionalmedian $1,905 · 10th–90th $1,230–$2,6300%20%10th90th$1,905$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,584.89 / $2,454.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,090.30 / $3,548.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $2,137.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $2,454.71 / $4,570.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,698.24 / $1,905.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,905.46 / $2,454.71
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $4,073.80