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New Mexico rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.97 / $146.97 / $146.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.38 / $200.62 / $854.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $138.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.12 / $266.41 / $399.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.52 / $71.52 / $200.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $138.76 / $312.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.68 / $251.68 / $296.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.43 / $110.79 / $169.54