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Montana rates for HCPCS 65782

Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.37 / $1,114.70 / $6,072.86
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,216.94 / $1,406.19 / $1,829.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.08 / $1,518.81 / $2,115.28
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
$1,691.04 / $1,886.15 / $2,178.83