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Alaska rates for HCPCS 65757

Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,285.00 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.56 / $697.56 / $697.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.65 / $413.65 / $413.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.19 / $156.29 / $997.51
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.70 / $120.70 / $172.43
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.75 / $513.00 / $695.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.29 / $156.29 / $997.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.43 / $602.25 / $816.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.08 / $429.26 / $1,299.86