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Montana rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.51 / $173.51 / $173.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.01 / $173.51 / $311.35