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Montana rates for HCPCS 65757

Backbench Prepj Corneal Endothelial Allograft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.96 / $160.96 / $160.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.80 / $199.80 / $199.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.72 / $129.72 / $199.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.80 / $199.80 / $199.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.96 / $172.78 / $240.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.00 / $200.00 / $200.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.58 / $186.44 / $233.57