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New Jersey rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.30 / $210.30 / $210.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.30 / $299.23 / $373.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.08 / $493.58 / $572.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $360.31 / $526.19
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.79 / $526.48 / $749.66
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.84 / $572.26 / $572.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.55 / $763.01 / $915.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.95 / $305.89 / $568.27