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Pennsylvania rates for HCPCS 65091

Evisceration Ocular Contents W/O Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$825.62 / $3,748.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.00 / $549.00 / $549.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,964.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.00 / $549.00 / $549.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.16 / $718.50 / $718.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,440.00 / $3,475.00 / $6,368.00