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Montana rates for HCPCS 15116

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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)

Facilitymedian $263 · 10th–90th $214–$2880%20%40%10th90th$263$200.0

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
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $263.03 / $288.40
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $158.49 / $323.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80