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New Mexico rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $72.27 / $90.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.60 / $43.24 / $116.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.22 / $71.55 / $90.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $83.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55