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New Mexico rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.69 / $150.69 / $150.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.40 / $205.72 / $884.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $159.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $159.21 / $159.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.54 / $273.18 / $409.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.51 / $78.51 / $205.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $159.21 / $320.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.44 / $139.21 / $183.23