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New Mexico rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.70 / $42.70 / $42.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $37.29 / $42.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $73.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.00 / $40.21 / $44.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $50.94