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New Mexico rates for HCPCS L1100

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $107.15 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $338.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $199.53 / $302.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $147.91 / $229.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $245.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $100.00 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $134.90