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Montana rates for HCPCS 15151

Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $134.90 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $169.82 / $199.53
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $199.53 / $218.78
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $199.53 / $218.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $125.89 / $213.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $162.18 / $223.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $194.98 / $218.78