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New Mexico rates for HCPCS Q4225

AmnioBind or DermaBind TL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,621.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,595.87 / $16,595.87 / $16,595.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $1,412.54 / $2,454.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,819.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,380.38 / $1,445.44