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Montana rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $162 · 10th–90th $117–$2400%20%10th90th$162Professionalmedian $132 · 10th–90th $68–$3550%10%10th90th$132$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
$67.61 / $128.82 / $363.08
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64,565.42 / $77,624.71 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $223.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $147.91 / $234.42
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $147.91 / $234.42
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $117.49 / $263.03
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $134.90 / $239.88