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Montana rates for HCPCS 65778

Placement of amniotic membrane on the ocular surface; without sutures

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $1,174.90 / $2,344.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $114.82 / $2,290.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $1,862.09 / $2,344.23
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $1,862.09 / $2,344.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $107.15 / $2,818.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $85.11 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $144.54 / $2,570.40