go back

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)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $75.86 / $154.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $77.62 / $128.82
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $95.50 / $144.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $95.50 / $144.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $69.18 / $125.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $85.11 / $134.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $107.15 / $144.54