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New Mexico rates for HCPCS L5990

Addition to lower extremity prosthesis, user adjustable heel height

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,202.26 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,174.90 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,778.28 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $3,235.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,187.76 / $3,311.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,621.81 / $2,187.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,479.11 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,071.52 / $1,479.11