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Montana rates for HCPCS 65778

Place Amniotic Membra Ocular Surface W/O Sutures

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.76 / $1,117.89 / $1,700.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.34 / $68.34 / $1,716.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.34 / $68.34 / $68.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.41 / $115.82 / $2,265.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.34 / $68.34 / $68.34
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.33 / $1,075.81 / $2,201.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$600.00 / $600.00 / $600.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,069.61 / $2,310.79 / $2,675.64