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Montana rates for HCPCS 65875

Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.24 / $993.24 / $993.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.66 / $756.55 / $993.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00