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Pennsylvania rates for HCPCS 66155

Fistulization of sclera for glaucoma; thermocauterization with iridectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.00 / $4,304.00 / $8,240.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.14 / $879.46 / $1,182.80
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.66 / $884.84 / $1,569.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.07 / $895.56 / $1,476.29
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.24 / $1,031.24 / $1,329.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,761.00 / $8,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.00 / $1,045.72 / $5,100.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.60 / $839.60 / $1,057.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.23 / $903.16 / $1,476.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$703.37 / $839.81 / $839.81
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.37 / $839.81 / $893.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,884.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.47 / $992.69 / $1,674.99