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New Mexico rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $4,073.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,235.94 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $70.79 / $3,019.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $3,715.35 / $6,309.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,818.38 / $2,951.21