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New Jersey rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.20 / $213.20 / $213.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.20 / $227.58 / $279.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $580.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $559.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.02 / $533.75 / $760.01
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
$552.21 / $580.16 / $580.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.24 / $289.43 / $532.62