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New Jersey rates for HCPCS L5210

Above knee (AK), short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,427.06 / $1,427.06 / $1,427.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.64 / $1,519.68 / $1,993.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $1,819.89 / $3,883.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.52 / $1,328.52 / $3,400.36
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,547.69 / $3,572.65 / $5,087.14
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,696.20 / $3,883.31 / $3,883.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,776.27 / $1,776.27 / $1,776.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,453.01 / $1,937.34 / $3,883.31