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New Mexico rates for HCPCS L3962

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, Erb's palsy design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.86 / $387.86 / $387.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.86 / $595.64 / $3,042.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.90 / $631.86 / $903.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $494.25 / $494.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $494.25 / $494.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.78 / $790.98 / $1,186.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.75 / $254.75 / $594.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $494.25 / $1,030.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.31 / $394.61 / $594.42