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New Jersey rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.73 / $200.73 / $200.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.73 / $243.93 / $355.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $546.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $478.30
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.02 / $502.53 / $715.56
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.42 / $546.23 / $546.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.30 / $272.51 / $546.23