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Montana rates for HCPCS 15136

Dermal Agrft F/S/N/H/F/G/M/D Gt Ea 100 Cm/Ea

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.31 / $477.13 / $511.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.34 / $139.34 / $139.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.61 / $147.83 / $158.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.02 / $103.32 / $185.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.87 / $142.35 / $183.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.65 / $164.13 / $179.36