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New Mexico rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,979.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,009.35 / $3,784.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,566.32 / $3,421.76 / $3,421.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,863.13 / $4,666.89 / $4,666.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,850.00 / $2,979.56 / $3,277.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $3,562.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,979.56