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New Mexico rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.73 / $2,145.78 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.12 / $107.74 / $477.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.87 / $124.56 / $157.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.59 / $82.96 / $150.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.15 / $123.82 / $142.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.33 / $141.16 / $173.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.00 / $1,158.00 / $1,401.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.15 / $138.66 / $199.15