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New Mexico rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.56 / $280.56 / $280.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $382.98 / $1,100.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.70 / $406.26 / $484.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $248.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $248.05 / $248.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.98 / $744.98 / $1,117.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.85 / $122.85 / $382.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $248.05 / $446.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.99 / $190.30 / $291.20