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Montana rates for HCPCS 67500

Retrobulbar injection; medication (separate procedure, does not include supply of medication)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.18 / $71.23 / $346.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.43 / $100.43 / $100.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.97 / $91.90 / $129.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.35 / $76.78 / $111.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.79 / $92.18 / $129.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.00 / $200.00 / $200.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.65 / $120.07 / $141.44