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New Jersey rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,511.89 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $5,011.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $3,311.31
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $5,370.32 / $7,413.10
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,011.87 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,630.27 / $4,073.80