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Arizona 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
$2,041.74 / $3,890.45 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $154.88 / $251.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,995.26 / $2,951.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $151.36 / $316.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $707.95 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $114.82 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $1,202.26 / $2,187.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $109.65 / $213.80