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New Mexico rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.39 / $310.39 / $310.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.27 / $423.72 / $1,576.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.10 / $449.47 / $535.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $362.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.13 / $562.66 / $844.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.02 / $161.02 / $422.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $362.03 / $640.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.62 / $249.43 / $381.69