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Montana rates for HCPCS A6021

Collagen Dressing Sterile Size 16 Sq. In. Or Less Each (Revised 01/01/13)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.61 / $8.61 / $84.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.69 / $28.69 / $77,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.85 / $30.85 / $30.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $30.85 / $30.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.05 / $27.96 / $30.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.15 / $23.15 / $34.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.26 / $12.46 / $14.26