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Wisconsin rates for HCPCS 65757

Backbench Prepj Corneal Endothelial Allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.10 / $186.10 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.65 / $186.10 / $250.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $1,183.00 / $1,530.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.05 / $239.11 / $599.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.43 / $219.03 / $353.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.90 / $224.21 / $287.22
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.93 / $126.61 / $223.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.93 / $1,100.00 / $2,043.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.78 / $133.72 / $448.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $70.00 / $194.50
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.93 / $128.10 / $250.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.32 / $299.74 / $427.20
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.00 / $908.00 / $908.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.91 / $569.29 / $935.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.37 / $328.37 / $328.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.41 / $696.21 / $696.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,423.00 / $2,202.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.78 / $140.75 / $286.64