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New Mexico rates for HCPCS 15276

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.81 / $2,145.78 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.10 / $29.73 / $51.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.66 / $442.44 / $720.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $31.16 / $49.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.04 / $37.92 / $52.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.57 / $32.34 / $50.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.94 / $33.70 / $54.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.82 / $42.41 / $62.20
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
$42.57 / $53.52 / $68.31