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New Jersey rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.90 / $83.90 / $83.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.90 / $99.94 / $142.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.73 / $169.96 / $228.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $285.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.56 / $210.02 / $299.05
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.28 / $228.28 / $228.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.94 / $118.48 / $228.28