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New Jersey rates for HCPCS L5647

Addition to lower extremity, below knee (BK), suction socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$367.25 / $367.25 / $367.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.25 / $426.37 / $802.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$552.41 / $596.58 / $999.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $1,107.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.99 / $919.40 / $1,309.15
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.93 / $999.35 / $999.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.41 / $717.49 / $999.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.61 / $534.20 / $999.35