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Maryland rates for HCPCS 67025

Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.33 / $800.20 / $1,686.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.34 / $672.61 / $706.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.00 / $335.55 / $1,205.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.72 / $701.35 / $1,327.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.49 / $864.90 / $1,182.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,009.00 / $1,009.00 / $1,009.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.78 / $697.47 / $1,497.26
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.81 / $788.49 / $864.90