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Michigan 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
$815.60 / $2,408.50 / $6,906.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,303.57 / $2,684.89 / $3,637.60
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.08 / $1,065.70 / $6,906.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $5,708.00 / $8,884.00