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Maine 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
Professional
Modifier
Low / Median / High Price
$138.04 / $194.98 / $263.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $154.88 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $213.80 / $281.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $186.21 / $281.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $194.98 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $204.17 / $269.15