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New Mexico rates for HCPCS L3201

Orthopedic shoe, Oxford with supinator or pronator, infant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.62 / $19.62 / $19.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.37 / $28.27 / $37.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.06 / $30.06 / $30.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $30.06 / $42.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $80.73 / $121.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.55 / $17.55 / $51.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $30.06 / $30.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.55 / $22.95 / $39.31