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Montana rates for HCPCS 15004

Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children

Facilitymedian $646 · 10th–90th $437–$8130%20%40%10th90th$646Professionalmedian $407 · 10th–90th $240–$9770%10%20%10th90th$407$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $398.11 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $407.38 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $426.58 / $660.69
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $660.69 / $724.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $660.69 / $724.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $363.08 / $660.69
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $416.87 / $660.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $501.19 / $724.44