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New Jersey rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,071.52 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,174.90 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,174.90
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,995.26 / $2,754.23
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,412.54 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $977.24 / $1,548.82