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New Mexico rates for HCPCS L3933

Finger orthosis (FO), without joints, may include soft interface, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.34 / $115.34 / $115.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.34 / $138.09 / $527.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$341.05 / $1,156.21 / $2,046.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.91 / $187.89 / $223.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.59 / $130.59 / $130.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.33 / $130.59 / $130.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.16 / $235.21 / $352.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.31 / $67.31 / $176.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.33 / $130.59 / $267.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.68 / $104.27 / $157.07