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Montana rates for HCPCS 67255

Scleral reinforcement (separate procedure); with graft

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.42 / $1,078.42 / $1,078.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.90 / $1,078.42 / $2,308.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00