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Montana rates for HCPCS A6215

Foam dressing, wound filler, sterile, per g

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.86 / $4.04 / $4.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $2.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.04 / $4.04 / $4.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $2,250,000.00