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New Mexico rates for HCPCS C5275

Application of low cost 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; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $5,000.27 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.58 / $27.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.64 / $1,984.65 / $3,403.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $386.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $27.58 / $27.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.00 / $1,158.00 / $1,401.00