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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
$354.81 / $354.81 / $354.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $354.81 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $512.86 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $1,122.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $645.65 / $954.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $478.63 / $691.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $426.58 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $323.59 / $426.58