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Michigan rates for HCPCS 67250

Scleral reinforcement (separate procedure); without graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,000.00 / $1,479.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,318.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,995.26 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $1,905.46
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $4,073.80 / $5,754.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $933.25 / $1,288.25
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $4,365.16 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $933.25 / $1,258.93