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Maine 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
$588.84 / $776.25 / $1,621.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $891.25 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $537.03 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,202.26 / $1,548.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $912.01 / $1,412.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $977.24 / $1,862.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $933.25 / $1,288.25