go back

New Jersey rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.88 / $219.88 / $219.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.88 / $289.07 / $387.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$378.14 / $499.82 / $598.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $523.92
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.63 / $550.47 / $783.83
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.32 / $598.34 / $598.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $435.50 / $435.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.80 / $310.52 / $598.34