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Montana rates for HCPCS 15278

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$55.56 / $296.66 / $490.43
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
$86.76 / $86.76 / $86.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.75 / $97.90 / $149.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.88 / $87.11 / $145.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.75 / $106.26 / $183.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.11 / $156.63 / $169.23