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Utah rates for HCPCS 65778

Place Amniotic Membra Ocular Surface W/O Sutures

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.29 / $2,870.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.14 / $1,064.01 / $1,412.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.36 / $1,144.00 / $2,111.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.98 / $1,093.99 / $1,378.77
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,408.37 / $1,919.63 / $2,797.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.86 / $158.61 / $2,581.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,209.31 / $1,423.32 / $2,308.40