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New Mexico rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,230 · 10th–90th $182–$2,3440%20%10th90th$1,230Professionalmedian $1,230 · 10th–90th $1,047–$1,4450%20%10th90th$1,230$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,258.93 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,445.44 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $144.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $812.83 / $1,737.80
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $1,230.27 / $2,570.40
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,445.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,698.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,047.13