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New Jersey rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $245.47 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $363.08 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $363.08
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $501.19 / $691.83
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $331.13 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $245.47 / $380.19