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Montana rates for HCPCS V2627

Scleral cover shell

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,522.02 / $1,683.64 / $1,700.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.34 / $742.34 / $742.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$930.02 / $1,438.33 / $2,009.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.34 / $1,805.62 / $1,962.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.34 / $771.56 / $1,106.90