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Nebraska 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
$115.11 / $8,477.27 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.11 / $115.11 / $219.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,065.60 / $6,609.33 / $12,887.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.60 / $108.42 / $144.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.39 / $205.49 / $284.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.11 / $218.71 / $4,317.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.67 / $136.87 / $187.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.30 / $229.13 / $393.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.48 / $200.63 / $393.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.00 / $1,775.00 / $4,406.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.60 / $147.07 / $176.71