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Utah rates for HCPCS 67025

Inj Substitute Pars Plana/Limbl W/Wo Aspir Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$648.58 / $2,870.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.58 / $737.62 / $1,346.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.80 / $928.03 / $1,238.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.16 / $426.85 / $672.63
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,435.37 / $4,418.50 / $6,439.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$874.09 / $1,054.60 / $1,415.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $3,613.00 / $7,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.32 / $747.90 / $1,212.19