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Pennsylvania rates for HCPCS 67255

Scleral Reinforcement Spx W/Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$768.00 / $3,745.00 / $8,017.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.00 / $549.00 / $549.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,964.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.00 / $549.00 / $549.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.62 / $659.62 / $803.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,894.00 / $6,000.00