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Pennsylvania 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
$1,282.03 / $4,304.00 / $8,240.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $4,761.00 / $8,247.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,114.41 / $1,143.35 / $1,143.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,884.00 / $6,000.00