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New Jersey rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.10 / $287.10 / $287.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.54 / $305.73 / $373.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.91 / $379.03 / $781.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $679.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.74 / $718.75 / $1,023.44
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.94 / $781.25 / $781.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.32 / $389.76 / $781.25