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New Mexico rates for HCPCS L3960

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, airplane design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$484.40 / $484.40 / $484.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.40 / $486.62 / $3,116.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.85 / $789.13 / $940.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $510.00 / $510.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $510.00 / $510.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.28 / $987.86 / $1,481.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.95 / $260.95 / $742.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $510.00 / $1,067.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.01 / $404.20 / $608.87