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Michigan rates for HCPCS 66172

Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,533.04 / $1,589.81 / $6,906.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,632.67 / $3,068.46 / $4,157.28
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,489.76 / $1,533.04 / $6,906.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $5,708.00 / $8,884.00