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New Mexico rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.74 / $240.74 / $240.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.74 / $328.63 / $1,303.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.45 / $348.61 / $415.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $366.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.12 / $436.40 / $654.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $140.55 / $366.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $609.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.30 / $217.72 / $333.17