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New Mexico rates for HCPCS L6895

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.72 / $369.72 / $369.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.72 / $504.69 / $1,933.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.54 / $535.38 / $637.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $418.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $418.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.16 / $670.20 / $1,005.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $215.86 / $503.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $785.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.14 / $334.36 / $503.78