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Montana rates for HCPCS 67042

Vitrectomy Pars Plana Remove Int Memb Retina

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,007.60 / $5,257.80 / $7,871.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.35 / $1,304.46 / $6,061.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,777.73 / $1,777.73 / $1,777.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,777.73 / $1,777.73 / $1,777.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.09 / $1,454.97 / $1,899.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,777.73 / $1,777.73 / $1,827.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.52 / $1,513.76 / $2,107.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,090.00 / $2,090.00 / $2,090.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.56 / $1,919.26 / $2,335.64