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Montana rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.95 / $662.76 / $782.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.32 / $964.32 / $1,220.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.32 / $964.32 / $964.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.71 / $1,024.90 / $1,271.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.91 / $750.27 / $1,373.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.36 / $1,037.32 / $1,448.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$946.24 / $946.24 / $946.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.85 / $1,278.55 / $1,393.09