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New Mexico rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.11 / $372.11 / $372.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.01 / $507.96 / $1,889.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.13 / $538.84 / $642.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $434.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.63 / $674.54 / $1,011.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $193.05 / $506.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $767.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.49 / $299.04 / $457.61