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Montana rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.60 / $29.26 / $40.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.07 / $42.79 / $56.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.44 / $31.66 / $56.43
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.84 / $44.26 / $61.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.92 / $57.82 / $62.99