go back

Montana rates for HCPCS 15261

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $208.93 / $676.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $223.87 / $354.81
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $288.40 / $371.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $371.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $204.17 / $331.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $213.80 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $257.04 / $380.19