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New Mexico rates for HCPCS L6697

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$880.66 / $880.66 / $880.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.21 / $1,202.17 / $4,471.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.44 / $1,275.25 / $1,519.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.22 / $1,111.22 / $1,111.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.19 / $811.19 / $1,951.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,277.12 / $1,596.41 / $2,394.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.00 / $457.00 / $1,199.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.19 / $1,111.22 / $1,859.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.50 / $773.22 / $1,083.25