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Montana rates for HCPCS 65779

Placement of amniotic membrane on the ocular surface; single layer, sutured

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $645.65 / $2,041.74
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
$181.97 / $181.97 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $467.74 / $1,995.26
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $1,995.26 / $2,137.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $1,995.26 / $2,137.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $416.87 / $2,511.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $208.93 / $1,905.46
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
$234.42 / $549.54 / $2,187.76