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Montana rates for HCPCS 65130

Insj Oc Implt Sec After Evsc Scll Shell

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.08 / $4,210.49 / $4,210.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.89 / $1,342.89 / $1,342.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.36 / $748.37 / $1,342.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$726.40 / $957.60 / $1,342.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.93 / $1,161.79 / $1,602.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,490.00 / $1,490.00 / $1,490.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.82 / $1,252.71 / $1,431.67