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North Dakota 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
$1,195.96 / $1,195.96 / $8,500.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.96 / $1,646.62 / $2,549.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,545.00 / $2,545.00 / $2,545.00