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Montana rates for HCPCS 15273

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.06 / $263.32 / $487.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.95 / $304.95 / $486.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.95 / $304.95 / $304.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.97 / $344.69 / $491.79
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.00 / $294.55 / $471.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.73 / $369.32 / $596.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.36 / $526.87 / $566.14