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New Jersey rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,732.50 / $1,732.50 / $1,732.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,732.50 / $2,105.36 / $3,065.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $4,714.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,107.31 / $4,128.16
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,307.01 / $4,337.32 / $6,175.97
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,128.16 / $4,714.47 / $4,714.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,890.35 / $5,753.36 / $6,904.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,125.77 / $2,479.86 / $4,714.47