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Nevada 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
$936.06 / $936.06 / $2,403.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$936.06 / $1,300.14 / $2,403.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,889.21 / $2,889.21 / $2,889.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,507.96 / $1,526.81 / $3,347.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.51 / $2,119.51 / $2,126.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.24 / $1,927.83 / $2,183.10
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,606.66 / $2,311.37 / $3,755.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.38 / $1,544.40 / $1,930.50