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New Hampshire rates for HCPCS 65780

Ocular Surface Reconstruction Amniotic Membrane

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,912.17 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.69 / $887.89 / $1,599.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,302.10 / $3,669.21 / $6,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.95 / $896.52 / $1,546.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.72 / $1,172.07 / $2,321.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,949.00 / $9,949.00 / $9,949.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.99 / $1,110.06 / $1,952.59
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.74 / $721.45 / $993.04