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Montana rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Facilitymedian $195 · 10th–90th $155$1,0230%20%10th90th$195Professionalmedian $138 · 10th–90th $52$5010%10%20%10th90th$138$20.0$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $338.84 / $1,995.26
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $123.03 / $457.09
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$158.49 / $181.97 / $630.96
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46,773.51 / $75,857.76 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $165.96 / $223.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $173.78 / $208.93
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $173.78 / $208.93
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $234.42 / $489.78
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $134.90 / $208.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $199.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $169.82 / $338.84