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New Mexico rates for HCPCS Q4126

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

Facilitymedian $174 · 10th–90th $63–$70,7950%20%10th90th$174Professionalmedian $63 · 10th–90th $62–$1260%20%40%10th90th$63$50.0$200.0$1.0K$5.0K$20.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $63.10 / $77.62
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $60,255.96 / $79,432.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $58.88 / $89.13
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $77.62 / $223.87
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $125.89