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Montana rates for HCPCS 65125

Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.92 / $1,551.52 / $2,462.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.18 / $462.18 / $462.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.02 / $462.18 / $750.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.99 / $462.18 / $579.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.57 / $473.18 / $727.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.92 / $751.68 / $868.32