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Montana rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Facilitymedian $1,380 · 10th–90th $1,148–$1,6220%50%10th90th$1,380Professionalmedian $1,202 · 10th–90th $708–$2,5700%10%20%10th90th$1,202$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
$707.95 / $1,047.13 / $3,019.95
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,096.48 / $1,318.26
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,380.38 / $1,513.56
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,380.38 / $1,513.56
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $851.14 / $1,584.89
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,071.52 / $1,548.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,096.48
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,258.93 / $1,445.44