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Pennsylvania rates for HCPCS 65778

Place Amniotic Membra Ocular Surface W/O Sutures

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $2,266.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.56 / $1,117.89 / $1,807.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.61 / $1,130.61 / $1,130.61
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.69 / $3,159.00 / $14,886.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.46 / $1,796.06 / $2,521.75
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,797.69 / $2,726.85 / $3,782.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.27 / $1,009.23 / $1,833.56
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,531.19 / $1,531.19 / $1,974.51
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,914.03 / $3,914.03 / $3,914.03
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.32 / $1,320.94 / $1,544.37
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$2,060.66 / $2,060.66 / $2,060.66
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $2,422.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.25 / $1,185.07 / $2,173.40
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.17 / $919.40 / $2,562.84
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.27 / $1,009.23 / $1,833.56
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.24 / $847.51 / $1,309.40
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.09 / $1,120.30 / $1,309.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.00 / $2,391.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,263.64 / $1,540.85 / $2,524.73