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New Mexico rates for HCPCS A6258

Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.98 / $5.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $46.77 / $79.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $7.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $8.91 / $60.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $5.50 / $9.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $6.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $2.51 / $3.80