go back

New Hampshire 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
$302.00 / $1,819.70 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $489.78 / $1,479.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,677.35 / $6,309.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $186.21 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $1,047.13 / $2,754.23
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $1,258.93 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $1,258.93 / $3,388.44