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New Jersey rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,677.92 / $1,677.92 / $1,677.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,677.92 / $2,039.02 / $3,107.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,669.57 / $2,853.06 / $4,565.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.73 / $2,082.73 / $3,998.08
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,171.31 / $4,200.64 / $5,981.36
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,345.92 / $4,565.92 / $4,565.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,058.79 / $2,607.55 / $4,191.75