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New Jersey rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,960.58 / $1,960.58 / $1,960.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,960.58 / $2,264.83 / $3,081.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,904.46 / $3,578.08 / $5,335.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $6,412.50
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,874.01 / $4,908.30 / $6,988.99
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,671.60 / $5,210.07 / $5,335.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,403.21 / $2,777.41 / $5,335.11