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New Mexico rates for HCPCS A2007

Restrata, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.90 / $229.90 / $229.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.60 / $200.86 / $229.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.70 / $205.70 / $205.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.70 / $205.70 / $205.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $85.00 / $138.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.98 / $205.70 / $242.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.70 / $205.70 / $275.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.00 / $220.00 / $220.00