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New Mexico rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $100.00 / $114.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $177.83 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $60.26 / $70.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $120.23 / $257.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $144.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $125.89