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New Jersey rates for HCPCS L5220

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Articulated Ankle/Foot Dynamically Aligned Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,302.55 / $1,302.55 / $1,302.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.55 / $1,484.69 / $2,333.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,177.79 / $2,482.86 / $3,544.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $1,812.49 / $3,103.68
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,238.15 / $3,260.93 / $4,643.28
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,373.70 / $3,544.49 / $3,544.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,182.50 / $2,487.91 / $3,544.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,598.22 / $2,024.22 / $3,544.49