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Montana rates for HCPCS 67912

Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight)

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.31 / $760.31 / $760.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.19 / $760.31 / $1,463.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $1,450.00 / $1,450.00