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Montana rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $95 · 10th–90th $74–$1510%20%10th90th$95Professionalmedian $78 · 10th–90th $42–$1510%20%10th90th$78$50.0$200.0$1.0K$5.0K$20.0K$100.0K

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
$39.81 / $75.86 / $154.88
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
$69.18 / $69.18 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $77.62 / $120.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $95.50 / $144.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $95.50 / $144.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $67.61 / $123.03
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $81.28 / $134.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $85.11 / $144.54