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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

Facilitymedian $1,259 · 10th–90th $1,047–$1,5850%20%40%10th90th$1,259Professionalmedian $871 · 10th–90th $562–$1,5490%10%20%10th90th$871$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $794.33 / $1,548.82
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $954.99 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $954.99 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $954.99 / $1,258.93
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,288.25 / $1,445.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,288.25 / $1,445.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $707.95 / $1,348.96
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $954.99 / $1,412.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,122.02 / $1,412.54