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Michigan 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
$1,445.44 / $2,041.74 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $912.01 / $1,737.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $234.42 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $812.83 / $2,187.76
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,951.21 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $1,202.26 / $1,819.70
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $776.25 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $6,309.57 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $1,047.13 / $1,659.59