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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
$630.96 / $812.83 / $1,258.93
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $645.65 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $338.84 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $707.95 / $1,479.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $660.69 / $1,258.93
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $831.76 / $1,230.27