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Utah rates for HCPCS 67255

Scleral reinforcement (separate procedure); with graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $5,888.44 / $8,511.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,073.80 / $9,120.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46