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New Mexico rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.08 / $5,000.27 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.87 / $263.32 / $496.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.00 / $1,840.75 / $2,999.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.16 / $271.95 / $612.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.85 / $320.30 / $498.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $262.25 / $462.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.61 / $262.69 / $523.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.26 / $349.53 / $542.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.00 / $9,127.00 / $13,891.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.53 / $479.04 / $600.99