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New Mexico rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$748.89 / $4,187.95 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.37 / $710.81 / $1,296.21
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
$388.64 / $728.15 / $1,095.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.23 / $911.21 / $1,222.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $652.26 / $1,166.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.29 / $807.58 / $1,190.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.67 / $981.99 / $1,415.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.00 / $3,085.00 / $5,060.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.63 / $1,120.98 / $1,428.70