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Utah rates for HCPCS 65782

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $6,025.60 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,202.26 / $2,454.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $851.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $6,456.54 / $14,791.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,905.46 / $2,511.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,778.28 / $2,344.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,698.24 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,148.15 / $1,862.09