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New Mexico rates for HCPCS L7403

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.55 / $246.55 / $246.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.53 / $336.56 / $1,251.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.77 / $357.02 / $425.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $546.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.55 / $446.94 / $670.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.91 / $127.91 / $335.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $286.80 / $520.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.19 / $198.13 / $298.45