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New Mexico rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.06 / $203.06 / $203.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.21 / $277.19 / $1,224.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.53 / $294.04 / $350.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $221.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.35 / $539.19 / $808.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.53 / $102.53 / $276.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $436.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.84 / $158.83 / $243.04