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Maine rates for HCPCS 67028

Intravitreal Njx Pharmacologic Agt Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.13 / $1,452.14 / $2,368.71
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,466.73 / $2,466.73 / $2,811.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.18 / $145.18 / $181.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.93 / $118.31 / $152.88
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$142.40 / $177.46 / $229.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.64 / $531.64 / $531.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.97 / $178.91 / $229.85
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.11 / $152.61 / $228.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.94 / $138.91 / $216.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,452.14 / $2,353.21 / $2,368.71
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$2,466.73 / $2,466.73 / $2,811.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.79 / $145.18 / $181.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.98 / $142.29 / $225.95