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New Jersey rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.77 / $57.77 / $57.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.32 / $62.89 / $88.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.79 / $99.25 / $157.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $166.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.61 / $144.62 / $205.93
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.65 / $157.19 / $157.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.54 / $94.08 / $94.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.58 / $78.43 / $157.19