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Maine rates for HCPCS 65782

Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.37 / $1,764.29 / $1,836.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.28 / $1,467.68 / $2,167.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,401.07 / $1,621.04 / $2,486.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.78 / $1,114.70 / $1,825.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.79 / $1,602.24 / $2,071.86