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Utah rates for HCPCS 66155

Fistulization of sclera for glaucoma; thermocauterization with iridectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $6,025.60 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $912.01 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,202.26 / $1,548.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $645.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $7,585.78 / $16,982.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,479.11 / $1,819.70
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,348.96 / $1,778.28
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,318.26 / $2,454.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,445.44