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New Mexico rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,980.61 / $2,490.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.00 / $2,258.56 / $2,312.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $2,014.00 / $3,282.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,157.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00