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New Mexico rates for HCPCS C5277

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 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
$1,000.00 / $5,000.27 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.00 / $964.00 / $964.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.63 / $2,088.69 / $3,403.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $386.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.00 / $1,158.00 / $1,401.00