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New Mexico rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,824.06 / $2,824.06 / $2,824.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,732.14 / $3,855.06 / $14,340.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,067.08 / $4,089.44 / $4,621.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.10 / $3,294.10 / $3,294.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,404.69 / $3,294.10 / $3,294.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,263.12 / $3,263.12 / $3,263.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,465.11 / $1,465.11 / $3,847.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,404.69 / $3,294.10 / $5,824.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,098.29 / $2,479.54 / $3,472.86