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New Mexico rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.58 / $50.58 / $50.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $44.19 / $50.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $85.00 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.74 / $45.25 / $53.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.47 / $45.25 / $45.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $44.36