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New Mexico rates for HCPCS L3971

Shoulder-elbow-wrist-hand orthotic (SEWHO), shoulder cap design, 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
$1,017.83 / $1,017.83 / $1,017.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.83 / $1,563.09 / $5,814.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.59 / $1,658.13 / $1,975.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $1,335.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,335.63 / $1,335.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,660.56 / $2,075.69 / $3,113.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.04 / $594.04 / $1,559.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,335.63 / $2,361.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.51 / $920.18 / $1,386.11