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Montana rates for HCPCS 15121

Split-thickness 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 $251 · 10th–90th $224–$3630%20%10th90th$251$100.0$200.0$500.0

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
$204.17 / $204.17 / $204.17
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $275.42 / $363.08
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $199.53 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84