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New Mexico rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $83.18 / $95.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $537.03 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $100.00 / $208.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $100.00 / $190.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $138.04 / $138.04