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Washington 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
$2,238.72 / $7,943.28 / $20,892.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $2,884.03
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $2,089.30 / $5,888.44
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,238.72 / $2,398.83
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,548.82 / $1,621.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $6,606.93 / $12,589.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $7,244.36 / $13,182.57