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Montana rates for HCPCS 65290

Repair of wound, extraocular muscle, tendon and/or Tenon's capsule

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $575.44 / $1,230.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $812.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,000.00
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $758.58 / $977.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $489.78 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $812.83 / $977.24