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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
$1,531.36 / $1,531.36 / $1,531.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,481.52 / $2,090.42 / $7,775.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.24 / $1,786.24 / $1,786.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.96 / $1,786.24 / $1,786.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,220.76 / $2,775.96 / $4,163.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.47 / $794.47 / $2,086.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.96 / $1,786.24 / $3,158.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.80 / $1,344.55 / $1,883.18