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Wisconsin rates for HCPCS 65780

Ocular Surface Reconstruction Amniotic Membrane

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,003.36 / $2,181.76 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.66 / $955.47 / $2,181.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,169.00 / $8,408.00 / $12,444.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.37 / $1,295.47 / $3,433.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.16 / $1,840.70 / $2,968.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.73 / $1,884.29 / $2,141.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$639.83 / $914.72 / $1,290.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.90 / $4,240.00 / $11,598.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.92 / $1,416.34 / $4,493.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.42 / $319.34 / $977.84
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$639.83 / $890.19 / $1,290.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,057.20 / $1,395.50 / $2,083.21
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,001.70 / $9,001.70 / $9,001.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,519.10 / $4,493.22 / $4,493.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,554.56 / $4,033.82 / $5,755.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.93 / $1,416.34 / $3,133.81