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New Jersey rates for HCPCS L5858

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,047.40 / $8,047.40 / $8,047.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,047.40 / $9,779.29 / $14,237.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,513.81 / $14,513.81 / $21,898.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,595.08 / $10,595.08 / $19,175.09
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,005.89 / $20,146.62 / $28,687.04
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,080.00 / $1,641.00 / $3,111.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,385.25 / $21,898.50 / $21,898.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,874.11 / $11,264.90 / $21,898.50