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Montana rates for HCPCS 67515

Injection Medication/Other Subst Tenon Capsule

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.76 / $78.45 / $180.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$108.51 / $108.51 / $108.51
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
$73.09 / $73.09 / $80.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.09 / $73.09 / $73.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.69 / $80.23 / $159.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.96 / $73.09 / $111.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.02 / $73.09 / $106.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.00 / $200.00 / $200.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.55 / $108.60 / $153.43