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New Mexico rates for HCPCS L1902

Ankle Orthosis Ankle Gauntlet Or Similiar With Or Without Joints Prefabricated Off-The-Shelf (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.80 / $58.80 / $58.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $58.80 / $236.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.41 / $69.41 / $69.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.69 / $818.11 / $1,528.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.84 / $95.79 / $114.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $58.00 / $58.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $58.00 / $58.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.52 / $175.65 / $263.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.97 / $28.97 / $90.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $58.00 / $129.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $44.87 / $67.59