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Montana rates for HCPCS 67115

Release Encircling Material Posterior Segment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.77 / $2,641.19 / $2,641.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$780.81 / $780.81 / $780.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.27 / $502.36 / $822.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$453.58 / $700.00 / $855.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.84 / $659.95 / $922.45
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
$733.20 / $817.79 / $944.69