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New Mexico rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.25 / $7,838.38 / $8,763.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.58 / $793.78 / $2,705.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,623.23 / $5,620.80 / $8,722.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.76 / $887.27 / $1,241.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.57 / $980.16 / $1,341.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $715.17 / $1,279.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.73 / $858.76 / $1,280.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.77 / $1,091.45 / $1,520.73
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
$843.20 / $1,220.42 / $1,555.44