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New Mexico rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,096.48 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $3,019.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,041.74 / $3,090.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,513.56 / $2,187.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,380.38 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $1,380.38