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Montana rates for HCPCS V2121

Lenticular Lens, Per Lens, Sngle

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.90 / $91.83 / $106.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.62 / $43.62 / $43.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.33 / $68.58 / $93.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.62 / $97.49 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.97 / $45.34 / $65.04