go back

New Jersey rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $53.70 / $85.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $60.26 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $60.26
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $102.33 / $141.25
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $95.50 / $95.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $72.44 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $50.12 / $79.43