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Montana rates for HCPCS V2115

Lenticular (myodisc), per lens, single vision

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.05 / $86.93 / $103.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.61 / $42.61 / $42.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.42 / $75.75 / $105.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.61 / $92.29 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.04 / $44.29 / $63.55