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New Mexico rates for HCPCS L6621

Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,479.11 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $4,073.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,754.23 / $4,168.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,995.26 / $2,818.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,862.09 / $3,388.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,348.96 / $1,862.09