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California rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$401.99 / $3,160.00 / $13,988.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$497.45 / $1,521.94 / $9,416.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.32 / $122.85 / $470.40
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$158.16 / $187.22 / $740.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.86 / $109.01 / $194.12
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$128.85 / $146.22 / $184.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,546.00 / $4,465.00 / $8,976.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.00 / $251.13 / $470.92
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$143.84 / $174.41 / $355.50
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $5,021.77
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.02 / $218.60 / $427.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.24 / $113.47 / $555.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.95 / $158.18 / $371.55
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.57 / $143.87 / $436.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.72 / $124.75 / $232.32
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $732.13 / $1,169.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,169.94 / $1,700.65 / $3,253.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.89 / $162.58 / $463.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.50 / $172.16 / $339.08
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.06 / $322.06 / $330.48
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.88 / $150.57 / $688.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.00 / $1,495.00 / $6,323.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.87 / $122.98 / $307.32