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New Mexico rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.28 / $435.28 / $435.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.43 / $594.19 / $2,276.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $400.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.23 / $789.04 / $1,183.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $190.60 / $592.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $400.78 / $755.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.97 / $295.24 / $454.95