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New Mexico rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.53 / $38.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.98 / $159.29 / $265.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.80 / $30.43 / $35.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.48 / $30.48 / $49.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $33.25 / $41.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $38.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23