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New Mexico rates for HCPCS L5505

Initial Above Knee - Knee Disarticulation Ischial Level Socket Non-Alignable System Pylon No Cover Sach Foot Plaster Socket Direct Formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,535.50 / $1,535.50 / $1,535.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.82 / $2,096.08 / $8,030.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $1,620.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $1,620.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,226.76 / $2,783.46 / $4,175.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.36 / $672.36 / $2,091.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $2,446.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,365.94 / $2,365.94 / $2,783.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.93 / $1,192.21 / $1,569.19