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New Jersey rates for HCPCS L5855

Addition Endoskeletal System Hip Disarticulation Mechanical Hip Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.22 / $136.22 / $136.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $165.53 / $315.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.78 / $239.78 / $370.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.04 / $175.04 / $324.57
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.63 / $341.03 / $485.59
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.99 / $370.68 / $370.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.02 / $247.02 / $247.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.14 / $198.14 / $370.68