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New Jersey rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,457.71 / $1,457.71 / $1,457.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,457.71 / $1,783.36 / $2,699.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,309.80 / $2,728.17 / $3,966.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $5,087.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,623.89 / $3,649.40 / $5,196.43
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,473.41 / $3,966.74 / $3,966.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800.65 / $2,141.53 / $3,966.74