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Montana rates for HCPCS 15131

Dermal 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
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.31 / $477.13 / $517.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.34 / $139.34 / $139.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.02 / $139.68 / $154.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.02 / $104.17 / $178.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.53 / $139.68 / $183.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $165.89 / $181.27