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Montana rates for HCPCS 15156

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$150.88 / $770.11 / $818.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.03 / $235.03 / $235.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.96 / $250.81 / $271.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.19 / $170.24 / $328.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.99 / $241.56 / $305.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.70 / $273.77 / $297.60