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New Mexico rates for HCPCS L3766

Elbow-wrist-hand-finger orthosis (EWHFO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $794.33 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $2,187.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,513.56 / $2,238.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $1,071.52 / $1,584.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $741.31 / $1,819.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $660.69 / $1,000.00