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Rhode Island rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,004.77 / $1,049.02 / $3,706.14
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$979.33 / $979.33 / $979.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.55 / $105.43 / $151.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.84 / $134.24 / $194.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.37 / $133.43 / $231.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,417.00 / $4,915.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.07 / $159.00 / $240.54