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New Hampshire rates for HCPCS 65757

Backbench Prepj Corneal Endothelial Allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.81 / $250.00 / $261.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.90 / $156.16 / $156.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.56 / $216.43 / $298.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.78 / $247.13 / $434.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.06 / $219.72 / $1,061.11
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.74 / $149.86 / $3,375.00