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New Mexico rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $89.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $87.10 / $128.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $97.72 / $263.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $83.18 / $125.89