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New Mexico rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.95 / $10.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.44 / $7.60 / $12.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.05 / $7.87 / $9.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87