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Utah 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
$3,162.28 / $4,570.88 / $8,709.64
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,073.80 / $9,120.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,584.89 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46