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Utah rates for HCPCS 65286

Rpr Lac Appl Tissue Glue Wound Cornea&/Sclera

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.84 / $2,744.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.84 / $698.02 / $1,504.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.95 / $779.68 / $1,183.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.01 / $384.73 / $627.39
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,435.37 / $4,418.50 / $6,439.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.28 / $973.44 / $1,360.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.76 / $719.63 / $1,159.65