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New Jersey rates for HCPCS L5656

Addition to lower extremity, socket insert, knee disarticulation (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.83 / $213.83 / $213.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.75 / $227.71 / $321.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.51 / $335.84 / $581.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $601.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.59 / $535.33 / $762.26
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.24 / $581.88 / $581.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.85 / $290.29 / $534.19