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New Mexico rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.38 / $380.38 / $380.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.05 / $519.25 / $1,674.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.12 / $550.82 / $656.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $499.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.62 / $689.53 / $1,034.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $186.64 / $518.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $499.82 / $808.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $382.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.30 / $289.10 / $442.41