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Montana rates for HCPCS 66155

Fstlj Sclera Glaucoma Thermocaut Irridec

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,060.42 / $4,649.08 / $4,649.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,373.39 / $1,373.39 / $1,373.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.45 / $881.91 / $1,441.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.71 / $1,120.00 / $1,373.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.34 / $1,165.00 / $1,624.19
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
$1,284.02 / $1,438.40 / $1,661.60