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New Mexico rates for HCPCS L6695

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.21 / $404.21 / $404.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.40 / $551.78 / $2,261.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.99 / $585.32 / $697.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $564.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $564.36 / $564.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.17 / $732.72 / $1,099.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.25 / $215.25 / $564.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $564.36 / $839.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.27 / $381.68 / $510.22