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Tennessee 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
$1,113.75 / $3,062.00 / $7,602.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,671.00 / $2,870.00 / $4,099.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,481.92 / $8,122.08 / $26,542.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.00 / $3,626.00 / $6,291.00