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Montana rates for HCPCS 15770

Graft; derma-fat-fascia

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.94 / $607.08 / $1,083.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,067.90 / $1,067.90 / $1,067.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.97 / $1,067.90 / $1,118.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.64 / $726.84 / $1,506.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.21 / $1,067.08 / $1,301.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.46 / $1,123.96 / $1,207.39