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New Mexico rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.19 / $32,892.80 / $36,587.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $25.82 / $29.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.40 / $171.30 / $286.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.97 / $33.58 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.20 / $31.11 / $35.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11