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New Mexico rates for HCPCS Q4218

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.50 / $142.50 / $142.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $124.50 / $142.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
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
$120.00 / $127.50 / $150.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00