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New Mexico rates for HCPCS L3730

Elbow orthosis (EO), double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $602.56 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $1,479.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,230.27 / $1,819.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $891.25 / $1,288.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $549.54 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $501.19 / $741.31