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Montana rates for HCPCS C9363

Skin substitute (Integra Meshed Bilayer Wound Matrix), per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.76 / $67.19 / $67.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.81 / $68.81 / $68.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.33 / $68.81 / $68.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.76 / $64.76 / $68.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.81 / $68.81 / $2,400,000.00