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West Virginia 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
$150.85 / $1,129.05 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.85 / $285.85 / $1,545.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.76 / $109.76 / $131.07
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.51 / $116.51 / $116.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.00 / $176.00 / $176.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.93 / $911.29 / $2,254.83
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,395.82 / $3,395.82 / $3,395.82
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.42 / $267.42 / $267.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.25 / $1,391.23 / $2,087.62