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New Mexico rates for HCPCS Q4190

Artacent AC, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $125.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $165.96 / $354.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $141.25 / $446.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $177.83 / $812.83