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New Mexico rates for HCPCS Q4219

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,000.00 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $60.26 / $85.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $1,047.13 / $1,737.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $794.33 / $794.33