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Michigan rates for HCPCS 65130

Insertion of ocular implant secondary; after evisceration, in scleral shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $1,862.09 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $812.83 / $1,819.70
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $4,073.80 / $5,754.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $870.96 / $1,230.27
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $758.58 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $6,309.57 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,174.90