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New Mexico rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $239.88 / $380.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $363.08 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $660.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $446.68 / $676.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $323.59 / $457.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $524.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $302.00 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $218.78 / $302.00