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Montana rates for HCPCS 67250

Scleral reinforcement (separate procedure); without graft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,096.48 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $812.83 / $1,412.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,548.82 / $1,737.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,548.82 / $1,737.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,122.02 / $1,862.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $870.96 / $1,737.80
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
$1,148.15 / $1,380.38 / $1,698.24