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New Mexico rates for HCPCS Q4151

AmnioBand or Guardian, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $136.22 / $171.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.34 / $132.88 / $161.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.44 / $144.44 / $222.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $148.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $174.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88