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Montana rates for HCPCS 65781

Ocular Surface Reconstruction Limbal Allograft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,604.51 / $7,032.61 / $7,032.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,411.40 / $1,629.40 / $2,105.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,241.58 / $1,758.96 / $2,449.17
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
$1,901.82 / $2,184.87 / $2,523.90