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Pennsylvania rates for HCPCS 65175

Removal Ocular Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$806.00 / $2,422.00 / $7,799.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.00 / $358.00 / $358.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $2,371.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.00 / $358.00 / $358.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.21 / $753.57 / $753.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $5,509.00 / $12,137.37