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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
$141.25 / $186.21 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $234.42 / $269.15
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $275.42 / $302.00
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $275.42 / $302.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $173.78 / $302.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $218.78 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $263.03 / $295.12