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Pennsylvania rates for HCPCS 65125

Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.42 / $2,747.00 / $8,113.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.52 / $425.40 / $600.85
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.08 / $450.46 / $811.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.00 / $771.00 / $771.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.58 / $389.59 / $613.71
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.17 / $537.17 / $692.71
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.52 / $440.70 / $1,551.52
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.40 / $342.40 / $342.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.00 / $771.00 / $771.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.04 / $391.53 / $613.71
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.02 / $281.00 / $436.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.02 / $335.57 / $470.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,884.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.62 / $512.79 / $868.12