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Montana rates for HCPCS 15136

Dermal 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 $155 · 10th–90th $135–$1780%20%10th90th$155Professionalmedian $141 · 10th–90th $89–$3020%10%10th90th$141$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
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $123.03 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $128.82 / $158.49
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $162.18 / $177.83
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $162.18 / $177.83
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $100.00 / $186.21
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $128.82 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $154.88 / $177.83