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Washington rates for HCPCS 65757

Backbench Prepj Corneal Endothelial Allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.85 / $7,920.26 / $27,982.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.65 / $191.85 / $697.56
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $170.78 / $908.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.17 / $312.25 / $1,108.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.30 / $255.17 / $394.46
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.00 / $193.91 / $327.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.93 / $211.20 / $327.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $339.11
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.38 / $103.57 / $110.87
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.78 / $170.78 / $173.66
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.08 / $286.89 / $347.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.17 / $249.81 / $332.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.00 / $414.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.36 / $184.46 / $307.62