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New Mexico rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $76.55 / $96.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.91 / $73.56 / $98.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.50 / $116.55 / $116.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $96.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $173.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79