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New Mexico rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.46 / $352.46 / $352.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.70 / $481.14 / $1,891.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.79 / $510.38 / $608.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$493.58 / $493.58 / $493.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $493.58 / $493.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.12 / $638.91 / $958.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.31 / $184.31 / $493.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $493.58 / $748.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.55 / $648.55 / $763.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.95 / $285.49 / $436.88