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Montana rates for HCPCS 67025

Inj Substitute Pars Plana/Limbl W/Wo Aspir Spx

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.60 / $904.27 / $3,340.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$985.35 / $985.35 / $1,160.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.35 / $985.35 / $985.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.19 / $737.87 / $1,194.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.90 / $881.18 / $1,145.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.96 / $884.70 / $1,194.26
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
$1,086.80 / $1,191.29 / $1,463.00