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New Mexico rates for HCPCS L5858

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,549.93 / $12,022.64 / $19,054.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,454.40 / $14,454.40 / $14,454.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $33,113.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,197.01 / $22,387.21 / $33,884.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $16,218.10 / $22,908.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $26,302.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $15,135.61 / $27,542.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,332.54 / $10,964.78 / $15,135.61