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Utah rates for HCPCS 65779

Place Amniotic Membrane Ocular Surface Sutured

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.08 / $2,870.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.81 / $964.25 / $1,324.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.88 / $1,033.22 / $1,999.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.64 / $945.57 / $1,200.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,469.55 / $7,330.88 / $10,683.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.74 / $617.85 / $2,313.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $6,097.00 / $8,267.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,087.05 / $1,242.56 / $1,910.58