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Michigan 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
$169.82 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $151.36 / $251.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $398.11 / $398.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $380.19 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $151.36 / $229.09
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $190.55 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $91.20 / $199.53
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $120.23 / $234.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $1,202.26 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $87.10 / $151.36