go back

New Jersey rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,290.87 / $3,630.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $3,019.95 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $3,019.95
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $5,495.41 / $7,585.78
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $3,162.28 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,630.27 / $3,981.07