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South Carolina 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
$158.49 / $9,120.11 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $158.49 / $251.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $199.53 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $194.98 / $316.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $158.49 / $281.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $1,202.26 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $112.20 / $186.21