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New Mexico rates for HCPCS L3702

Elbow Orthosis Without Joints May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.10 / $156.10 / $156.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $169.87 / $697.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.59 / $1,564.66 / $2,770.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.73 / $254.30 / $303.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.75 / $176.75 / $176.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $176.75 / $176.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.67 / $318.33 / $477.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.10 / $91.10 / $239.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.03 / $176.75 / $362.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.13 / $141.11 / $212.57