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Montana rates for HCPCS 65757

Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $151.36 / $218.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,565.42 / $83,176.38 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $199.53
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $218.78 / $239.88
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $218.78 / $239.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $199.53 / $251.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $123.03 / $245.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $190.55 / $245.47