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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)

Facilitymedian $3,162 · 10th–90th $741–$4,6770%10%10th90th$3,162Professionalmedian $759 · 10th–90th $631–$1,4130%20%10th90th$759$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $741.31 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $933.25 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,348.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,235.94 / $4,466.84 / $6,760.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,122.02 / $1,513.56
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,174.90 / $1,862.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $933.25 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,677.35 / $7,079.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $691.83 / $1,071.52