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Maryland rates for HCPCS 65875

Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $1,905.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $630.96 / $1,202.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $630.96 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,621.81