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Utah rates for HCPCS 67025

Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $758.58 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $933.25 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,348.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,073.80 / $9,120.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,258.93 / $1,513.56
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,174.90 / $1,862.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $933.25 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $691.83 / $1,071.52