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New Mexico rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $363.08 / $575.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $537.03 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $676.08 / $1,023.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $501.19 / $741.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $457.09 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $346.74 / $457.09