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Pennsylvania rates for HCPCS 67028

Intravitreal Njx Pharmacologic Agt Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.29 / $930.61 / $4,761.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$455.62 / $638.86 / $2,118.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.82 / $118.62 / $359.79
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$41.49 / $189.41 / $590.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.44 / $113.92 / $171.10
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$156.66 / $170.87 / $256.64
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.20 / $139.47 / $625.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.71 / $161.16 / $344.38
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$166.06 / $248.70 / $516.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.00 / $358.00 / $358.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.85 / $132.18 / $257.95
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.63 / $133.63 / $172.34
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.54 / $721.81 / $1,914.85
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$661.49 / $1,082.70 / $2,973.48
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.67 / $138.27 / $236.70
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$168.63 / $207.41 / $591.00
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.92 / $139.47 / $625.87
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.90 / $1,777.00 / $7,175.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$638.86 / $759.67 / $2,555.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.07 / $124.56 / $468.53
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$90.41 / $204.33 / $702.79
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$534.50 / $552.30 / $3,923.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.69 / $432.90 / $432.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.00 / $358.00 / $358.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.55 / $125.33 / $222.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.22 / $109.08 / $513.08
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.99 / $108.39 / $513.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $650.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.78 / $141.51 / $237.26