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Montana rates for HCPCS A2015

Phoenix wound matrix, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.95 / $81.50 / $540.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.23 / $728.23 / $728.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$728.23 / $728.23 / $785.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.50 / $728.23 / $728.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$728.23 / $728.23 / $785.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.66 / $1,438.66 / $1,438.66