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New Mexico rates for HCPCS L6694

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.07 / $485.07 / $485.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.70 / $662.16 / $2,713.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$526.82 / $702.42 / $836.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $528.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $528.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.44 / $879.31 / $1,318.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $258.31 / $660.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $1,007.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.94 / $458.02 / $612.29