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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
$1,000.00 / $1,000.00 / $1,000.00
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,071.52 / $1,288.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44