go back

Montana rates for HCPCS A2013

Innovamatrix Fs, Per Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.00 / $1,344.60 / $1,344.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.00 / $1,818.74 / $1,818.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.00 / $1,818.74 / $1,818.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,296.00 / $1,620.00 / $1,818.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.00 / $1,818.74 / $2,250,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $1,350.00