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Virginia 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
$812.83 / $5,370.32 / $9,772.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,981.07 / $4,466.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $616.60 / $794.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $831.76 / $870.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $758.58 / $1,174.90
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $794.33 / $8,709.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $7,244.36 / $14,125.38