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Montana rates for HCPCS A6412

Eye patch, occlusive, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.58 / $1.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.52
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.58 / $0.60
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.58 / $0.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.21 / $0.38 / $0.62
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $79.43 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.22 / $0.22