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New Mexico rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$744.37 / $744.37 / $744.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.37 / $1,143.15 / $5,526.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.58 / $897.58 / $897.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $1,956.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.42 / $1,518.03 / $2,277.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.65 / $462.65 / $1,140.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $897.58 / $1,912.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.70 / $716.63 / $1,079.50