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Pennsylvania rates for HCPCS 65155

Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,786.30 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,047.13 / $1,905.46
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $977.24 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,548.82
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,445.44
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $891.25 / $1,445.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $3,801.89 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,174.90 / $2,754.23
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,584.89
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $933.25
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $776.25 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $4,168.69 / $12,022.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,584.89