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Montana rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Facilitymedian $1,585 · 10th–90th $1,349–$5,2480%20%40%10th90th$1,585Professionalmedian $1,047 · 10th–90th $741–$1,9050%20%10th90th$1,047$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
Facility
Modifier
Typical Low / Median / Typical High
$5,370.32 / $5,370.32 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $954.99 / $1,995.26
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
$1,071.52 / $1,258.93 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,258.93 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,258.93 / $1,548.82
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,584.89 / $1,737.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,584.89 / $1,737.80
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $912.01 / $1,621.81
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,258.93 / $1,778.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,202.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,445.44 / $1,698.24