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New Jersey rates for HCPCS L5857

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $5,011.87 / $8,709.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $10,471.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,606.93
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $10,964.78 / $15,135.61
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,232.93 / $10,232.93 / $10,232.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $10,232.93 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $5,370.32 / $8,317.64