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Maryland rates for HCPCS 65778

Placement of amniotic membrane on the ocular surface; without sutures

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $870.96 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $1,230.27 / $2,187.76
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $43.65 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $426.58 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $933.25 / $2,238.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $707.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $954.99 / $1,995.26
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $1,380.38 / $1,862.09