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New Mexico rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.88 / $5,000.27 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.87 / $703.24 / $3,141.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.97 / $616.61 / $852.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.53 / $826.69 / $1,154.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $610.82 / $1,094.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.82 / $872.61 / $1,099.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.22 / $966.84 / $1,241.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$639.00 / $6,599.00 / $8,422.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.04 / $1,052.13 / $1,340.95