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Montana rates for HCPCS V2625

Enlargement of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.16 / $483.61 / $488.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.23 / $213.23 / $213.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.33 / $419.25 / $585.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.23 / $518.65 / $563.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.31 / $221.62 / $317.95