go back

New Mexico rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $63.04 / $79.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,000.00 / $55,999.99 / $69,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.67 / $59.54 / $103.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $87.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $109.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41