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Utah rates for HCPCS 67042

Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)

Facilitymedian $5,888 · 10th–90th $1,549–$8,7100%10%10th90th$5,888Professionalmedian $1,318 · 10th–90th $407–$2,5700%10%20%10th90th$1,318$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
$1,548.82 / $5,888.44 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $1,230.27 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,778.28 / $2,290.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $3,235.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $7,943.28 / $12,022.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $1,737.80 / $3,235.94
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $2,630.27 / $3,467.37
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,698.24 / $2,884.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,380.38 / $2,238.72