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Wisconsin rates for HCPCS 65778

Placement of amniotic membrane on the ocular surface; without sutures

Facilitymedian $4,266 · 10th–90th $1,413$7,0790%10%10th90th$4,266Professionalmedian $324 · 10th–90th $56$2,6920%5%10th90th$324$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $1,905.46 / $4,677.35
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $1,071.52 / $2,344.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $154.88 / $1,380.38
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$128.82 / $234.42 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,548.13 / $5,623.41
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $190.55 / $4,073.80
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $2,041.74 / $10,232.93
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $181.97 / $3,548.13
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$141.25 / $275.42 / $5,248.07
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $2,344.23 / $5,623.41
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $2,818.38 / $8,912.51
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $208.93
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $3,890.45 / $4,570.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $1,737.80 / $5,011.87
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $1,412.54 / $4,168.69
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $3,890.45 / $3,890.45
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $3,019.95 / $8,912.51
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $6,606.93
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $5,370.32 / $10,715.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $3,311.31 / $6,606.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $104.71 / $5,888.44