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Montana rates for HCPCS 15150

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.08 / $3,292.63 / $3,653.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,012.17 / $1,012.17 / $1,012.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.89 / $1,061.57 / $1,158.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.96 / $749.82 / $1,393.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.46 / $1,029.86 / $1,355.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.27 / $868.27 / $868.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.02 / $1,182.34 / $1,286.60