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New Jersey 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
$1,025.97 / $1,025.97 / $1,025.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.97 / $1,187.19 / $1,610.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $2,791.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $1,547.24 / $2,444.65
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,550.56 / $2,568.50 / $3,657.32
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,657.33 / $2,791.85 / $2,791.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,252.58 / $1,408.01 / $2,296.40