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Utah rates for HCPCS 65781

Ocular Surface Reconstruction Limbal Allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,311.25 / $4,387.00 / $9,078.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,311.25 / $1,311.25 / $2,841.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.65 / $769.98 / $1,197.77
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,270.51 / $9,909.79 / $14,441.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.45 / $1,901.61 / $2,783.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.39 / $1,318.46 / $2,109.52