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Connecticut rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $4,677.35 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $151.36 / $562.34
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$151.36 / $275.42 / $758.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,162.28 / $47,863.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $194.98 / $269.15
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$158.49 / $295.12 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $208.93 / $398.11
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $204.17 / $537.03
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $346.74 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $3,890.45 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $144.54 / $288.40