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Utah rates for HCPCS 67250

Scleral reinforcement (separate procedure); without graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $933.25 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,174.90 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $660.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,890.45 / $8,912.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,513.56 / $1,698.24
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,445.44 / $2,089.30
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,202.26 / $1,584.89
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
$660.69 / $831.76 / $1,348.96