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New Mexico rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$340.24 / $5,000.27 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.97 / $331.69 / $1,183.70
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
$171.71 / $295.13 / $503.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.13 / $349.45 / $548.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $289.92 / $517.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.15 / $303.69 / $584.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.00 / $390.40 / $557.52
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
$388.65 / $481.79 / $688.97