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New Mexico rates for HCPCS L1900

Ankle-foot orthosis (AFO), spring wire, dorsiflexion assist calf band, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $181.97 / $295.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $309.03 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $501.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $389.05 / $588.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $281.84 / $371.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $169.82 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $151.36 / $229.09