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Montana rates for HCPCS 65780

Ocular Surface Reconstruction Amniotic Membrane

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.22 / $776.38 / $1,447.13
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
$925.93 / $925.93 / $925.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$922.67 / $1,075.78 / $1,373.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.62 / $887.73 / $1,239.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,800.00 / $5,800.00 / $5,800.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.68 / $1,111.56 / $1,343.77