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Montana rates for HCPCS 15110

Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,129.42 / $1,129.42 / $1,129.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$628.07 / $835.82 / $1,678.79