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New Hampshire rates for HCPCS 65782

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,890.45 / $15,848.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,174.90 / $1,778.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,677.35 / $6,309.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $2,041.74 / $3,162.28
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,905.46 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,737.80 / $3,388.44