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New Mexico rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $742.40 / $933.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.24 / $958.98 / $966.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$972.83 / $1,459.24 / $1,524.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $933.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $1,207.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05