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New Jersey rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $3,311.31 / $5,623.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $4,365.16 / $6,760.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $4,365.16
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $7,079.46 / $9,772.37
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,677.35 / $7,244.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,467.37 / $5,248.07