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Utah rates for HCPCS 65290

Repair of wound, extraocular muscle, tendon and/or Tenon's capsule

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $512.86 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $707.95 / $870.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $363.08
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
$630.96 / $812.83 / $1,071.52
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $758.58 / $1,000.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $724.44 / $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
$389.05 / $489.78 / $812.83