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New Mexico rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,778.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $8,511.38 / $13,489.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $831.76 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,071.52 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $239.88 / $1,288.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,023.29 / $1,348.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,096.48 / $1,479.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $9,120.11 / $15,488.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $1,479.11