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Montana rates for HCPCS 66155

Fistulization of sclera for glaucoma; thermocauterization with iridectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,047.13 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $891.25 / $1,445.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,479.11 / $1,778.28
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,479.11 / $1,778.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $1,621.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $851.14 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,445.44 / $1,737.80