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Delaware rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,140.00 / $3,140.00 / $6,907.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,117.52 / $1,117.52 / $1,117.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.54 / $108.47 / $135.69
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$190.73 / $445.00 / $681.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.00 / $418.00 / $418.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.85 / $115.53 / $188.33
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.96 / $507.96 / $507.96
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.78 / $113.78 / $196.22
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$165.71 / $165.71 / $175.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.92 / $162.29 / $230.14