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Montana rates for HCPCS 66150

Fistulization of sclera for glaucoma; trephination with iridectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,060.83 / $4,652.85 / $4,652.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,373.92 / $1,373.92 / $1,373.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.16 / $882.61 / $1,434.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$795.37 / $1,120.00 / $1,373.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.66 / $1,165.46 / $1,625.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,285.24 / $1,439.55 / $1,662.93