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New Mexico rates for HCPCS L7400

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.19 / $205.19 / $205.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.52 / $280.10 / $1,041.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.86 / $297.14 / $354.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $239.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $454.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.57 / $371.97 / $557.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $106.46 / $279.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $239.35 / $433.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.46 / $164.90 / $252.34