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New Mexico rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.04 / $255.04 / $255.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.25 / $348.15 / $1,328.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.98 / $369.31 / $440.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.98 / $232.98 / $232.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $232.98 / $232.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.77 / $677.22 / $1,015.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.68 / $111.68 / $347.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $232.98 / $418.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.94 / $172.98 / $260.57