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Pennsylvania rates for HCPCS 67027

Impltj Intravitreal Drug Dlvr Sys Rmvl Vts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.04 / $4,304.00 / $8,240.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,761.00 / $8,247.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.00 / $678.00 / $678.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.63 / $812.50 / $943.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,843.00 / $3,879.00 / $7,508.00