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Idaho rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.98 / $1,407.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.32 / $125.97 / $465.36
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$158.16 / $187.22 / $681.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.11 / $142.28 / $193.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.53 / $221.08 / $407.45
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.85 / $177.26 / $218.02
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$167.78 / $167.78 / $167.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $197.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.51 / $883.79 / $1,109.29
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,107.83 / $1,107.83 / $1,221.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.00 / $182.38 / $224.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.00 / $1,800.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.68 / $148.72 / $213.31