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Montana rates for HCPCS 65103

Enucleation Eye Implt Musc X Attached Implt

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,381.28 / $1,381.28 / $1,381.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$770.80 / $1,111.50 / $1,381.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,490.00 / $1,490.00 / $1,490.00