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Montana rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

Facilitymedian $1,175 · 10th–90th $1,047–$1,3180%50%10th90th$1,175Professionalmedian $1,072 · 10th–90th $646–$2,2910%10%20%10th90th$1,072$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$645.65 / $912.01 / $2,691.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $954.99 / $1,148.15
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,174.90 / $1,318.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,174.90 / $1,318.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $758.58 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $954.99 / $1,348.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $977.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,122.02 / $1,288.25