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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
$1,548.82 / $4,897.79 / $6,918.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,778.28 / $1,778.28
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $4,365.16 / $6,918.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $4,365.16 / $7,413.10