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New Jersey rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.90 / $186.90 / $186.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.25 / $220.75 / $243.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $508.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $181.08 / $442.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.62 / $467.88 / $666.23
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.65 / $508.57 / $508.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.21 / $253.73 / $466.90