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New Mexico rates for HCPCS L4130

Replace pretibial shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.44 / $319.44 / $319.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.44 / $490.56 / $2,150.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.57 / $373.57 / $373.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $373.57 / $373.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.15 / $651.44 / $977.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.02 / $180.02 / $489.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $373.57 / $780.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.85 / $276.36 / $278.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.19 / $278.85 / $420.05