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Missouri 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
$143.61 / $3,762.57 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.12 / $143.61 / $193.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.61 / $74.18 / $129.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.00 / $591.00 / $591.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.69 / $141.99 / $287.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $302.14 / $1,261.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.80 / $97.04 / $275.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $875.00 / $1,351.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.63 / $97.04 / $148.28