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New Mexico rates for HCPCS L7405

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.69 / $486.69 / $486.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.83 / $664.37 / $2,471.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.57 / $704.76 / $839.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.54 / $624.54 / $624.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.91 / $624.54 / $624.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.79 / $882.24 / $1,323.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.48 / $252.48 / $662.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.91 / $624.54 / $1,003.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.60 / $391.10 / $598.48