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Arizona rates for HCPCS 65779

Placement of amniotic membrane on the ocular surface; single layer, sutured

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.00 / $2,640.00 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.15 / $893.51 / $1,459.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$944.35 / $3,670.74 / $5,814.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.85 / $628.49 / $1,004.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.00 / $250.00 / $250.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.69 / $984.93 / $1,865.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.15 / $1,424.00 / $6,117.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,101.75 / $1,336.40 / $4,269.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,523.00 / $4,398.00 / $7,217.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.11 / $1,239.48 / $2,243.27