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West Virginia 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
$132.44 / $132.44 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.16 / $132.44 / $219.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.15 / $116.15 / $141.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.99 / $125.99 / $125.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.26 / $142.26 / $142.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.20 / $167.31 / $592.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.32 / $93.54 / $163.32