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Pennsylvania 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
$675.29 / $2,240.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.28 / $721.17 / $1,191.76
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.38 / $742.38 / $1,300.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.00 / $358.00 / $358.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.18 / $711.19 / $1,154.26
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$869.38 / $869.38 / $1,121.08
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.41 / $585.41 / $585.41
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $2,371.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.33 / $754.17 / $1,767.77
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$901.70 / $901.70 / $901.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.00 / $358.00 / $358.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.61 / $730.10 / $1,154.26
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.15 / $604.95 / $891.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.89 / $699.91 / $891.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.00 / $2,949.00 / $6,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.90 / $824.28 / $1,432.77