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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
$35.40 / $35.40 / $35.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.40 / $44.40 / $61.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.46 / $60.21 / $96.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $84.37
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.02 / $88.64 / $126.22
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.71 / $96.35 / $96.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.44 / $55.03 / $96.35