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Montana rates for HCPCS 65286

Rpr Lac Appl Tissue Glue Wound Cornea&/Sclera

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.91 / $857.49 / $3,765.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.45 / $773.45 / $1,094.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.45 / $773.45 / $773.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.17 / $745.79 / $1,157.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.66 / $641.25 / $870.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.67 / $773.45 / $1,111.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600.00 / $600.00 / $600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.89 / $1,156.52 / $1,335.99