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Montana rates for HCPCS V2623

Prosthetic eye, plastic, custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.85 / $4,144.67 / $4,144.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,113.25 / $1,113.25 / $1,113.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.14 / $856.71 / $856.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.00 / $1,139.97 / $1,370.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.71 / $1,229.08 / $1,683.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.80 / $537.49 / $716.66