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Montana rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Facilitymedian $257 · 10th–90th $158–$4,0740%20%10th90th$257Professionalmedian $155 · 10th–90th $83–$3980%10%20%10th90th$155$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
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $4,073.80 / $7,079.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $138.04 / $489.78
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $162.18 / $251.19
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $251.19 / $295.12
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $251.19 / $295.12
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $141.25 / $239.88
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $154.88 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $204.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $194.98 / $288.40