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Montana rates for HCPCS 76513

Dx Ophthalmic Us Ant Segment Immersion Uni/Bi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.14 / $96.27 / $142.22
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.80 / $34.79 / $50.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$49.35 / $61.46 / $80.95
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$49.95 / $49.95 / $61.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.75 / $126.17 / $200.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.28 / $49.95 / $75.05
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$57.42 / $78.65 / $128.88
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$49.95 / $49.95 / $61.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.51 / $137.76 / $219.10
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.48 / $49.95 / $61.67
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$68.34 / $78.65 / $105.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.70 / $101.41 / $178.09
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.29 / $36.81 / $64.64
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$49.41 / $64.59 / $113.45