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New Jersey rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.58 / $89.58 / $89.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.58 / $117.67 / $160.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $243.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $116.22 / $213.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.70 / $224.26 / $319.33
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.05 / $243.76 / $243.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.91 / $131.44 / $243.76