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New Mexico rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.74 / $85.74 / $85.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.96 / $117.04 / $435.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.12 / $124.16 / $147.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $100.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.13 / $227.67 / $341.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.49 / $44.49 / $116.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $176.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.71 / $75.29 / $105.46