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Utah 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
$630.96 / $6,025.60 / $8,709.64
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,073.80 / $9,120.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $954.99 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46