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Pennsylvania rates for HCPCS 65781

Ocular Surface Reconstruction Limbal Allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,419.81 / $4,761.00 / $8,451.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,228.14 / $1,324.20 / $1,788.70
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,295.70 / $1,344.60 / $2,399.35
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,554.48 / $1,554.48 / $2,004.54
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.00 / $5,342.00 / $9,617.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.02 / $1,489.64 / $7,032.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $2,387.19 / $3,345.10
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,173.77 / $1,271.40 / $1,271.40
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,173.77 / $1,271.40 / $1,345.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,843.00 / $3,914.00 / $8,243.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,106.58 / $1,434.65 / $2,464.82