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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
$8,128.31 / $8,128.31 / $8,128.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,511.38 / $10,964.78 / $18,620.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $22,387.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $14,454.40
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,454.40 / $23,442.29 / $32,359.37
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,877.62 / $21,877.62 / $21,877.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $21,877.62 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,772.37 / $11,481.54 / $18,197.01