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Utah rates for HCPCS 67041

Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $7,413.10 / $9,120.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,202.26 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,698.24 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,235.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $7,585.78 / $16,982.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,905.46 / $2,818.38
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $2,398.83 / $3,467.37
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,698.24 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,230.27 / $1,905.46