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Montana rates for HCPCS 65286

Repair of laceration; application of tissue glue, wounds of cornea and/or sclera

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $758.58 / $1,584.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $741.31 / $1,148.15
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,148.15 / $1,288.25
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,148.15 / $1,288.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $691.83 / $1,000.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $691.83 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,318.26