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New Mexico rates for HCPCS L8000

Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.83 / $24.83 / $24.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.83 / $33.90 / $168.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.28 / $219.17 / $391.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.97 / $35.96 / $42.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.00 / $35.00 / $35.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $35.00 / $35.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.01 / $45.02 / $67.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $14.11 / $35.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.55 / $35.00 / $52.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.21 / $21.86 / $39.29