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New Mexico rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.02 / $261.02 / $261.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.07 / $356.31 / $1,411.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.48 / $377.97 / $450.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $306.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.52 / $473.15 / $709.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.19 / $128.19 / $355.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $544.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.61 / $227.33 / $303.88