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Montana rates for HCPCS A2002

Mirragen Advanced Wound Matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $128.82 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $281.84 / $302.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $165.96 / $281.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89