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New Mexico rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$320.05 / $320.05 / $320.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.33 / $436.89 / $1,312.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.59 / $463.45 / $552.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $274.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $592.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.12 / $580.16 / $870.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.13 / $140.13 / $435.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $274.54 / $602.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.71 / $217.07 / $332.18