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New Mexico rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.51 / $117.51 / $117.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.46 / $160.41 / $606.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.63 / $170.17 / $202.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.00 / $113.00 / $113.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.49 / $113.00 / $113.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.41 / $213.02 / $319.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.56 / $56.56 / $160.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.49 / $113.00 / $206.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.00 / $87.61 / $131.99