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Montana rates for HCPCS V2624

Polishing/resurfacing of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.55 / $80.36 / $83.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.74 / $90.74 / $90.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $35.07 / $35.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.94 / $66.52 / $92.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $85.31 / $92.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.95 / $36.46 / $52.29