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Montana rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $229 · 10th–90th $182–$3240%20%10th90th$229Professionalmedian $195 · 10th–90th $107–$4680%20%10th90th$195$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
$107.15 / $186.21 / $562.34
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64,565.42 / $77,624.71 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $165.96 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $186.21 / $309.03
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $229.09 / $316.23
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $229.09 / $316.23
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $158.49 / $331.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $165.96 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $204.17 / $323.59