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Montana rates for HCPCS 15760

Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $2,137.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,148.15 / $1,412.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $1,584.89
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $1,584.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,412.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,096.48 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,258.93 / $1,513.56