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New Mexico rates for HCPCS A6025

Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.44 / $13.44 / $13.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.51 / $12.31 / $13.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $18.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $85.00 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.31 / $22.37 / $26.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.61 / $18.66