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New Mexico rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$970.83 / $5,000.27 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.71 / $970.83 / $1,499.73
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
$457.17 / $1,005.44 / $1,472.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.58 / $1,253.17 / $1,598.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $847.81 / $1,522.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$742.59 / $1,047.35 / $1,539.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.72 / $1,359.69 / $1,855.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.00 / $3,503.00 / $5,060.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.02 / $1,453.50 / $1,852.49