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New Mexico rates for HCPCS L3675

Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.86 / $94.86 / $94.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.13 / $145.68 / $541.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.91 / $154.54 / $184.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $107.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $107.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.76 / $193.46 / $290.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.36 / $55.36 / $145.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $220.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.08 / $85.00 / $85.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.87 / $85.76 / $129.18