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Utah rates for HCPCS 65150

Reinsertion of ocular implant; with or without conjunctival graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $3,715.35 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $724.44 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $831.76 / $1,174.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $512.86
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
$912.01 / $1,096.48 / $1,230.27
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,023.29 / $1,288.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,047.13 / $1,862.09
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
$489.78 / $616.60 / $1,000.00