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Montana rates for HCPCS 0253T

Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the suprachoroidal space

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $933.25 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,548.82
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $12,302.69
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $12,302.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,096.48 / $1,548.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,548.82 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,698.24 / $2,398.83