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New Mexico rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $6,918.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $4,168.69 / $6,309.57
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,162.28 / $5,370.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $5,623.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,162.28 / $5,623.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,398.83 / $3,162.28