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Missouri 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
Facility
Modifier
Low / Median / High Price
$818.00 / $2,598.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.50 / $763.11 / $1,134.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,852.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.00 / $727.63 / $1,053.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.00 / $386.00 / $1,344.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$541.26 / $822.55 / $1,537.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$697.72 / $1,716.00 / $12,000.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.69 / $961.50 / $5,516.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,644.00 / $2,874.00 / $5,813.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.69 / $846.52 / $1,471.70