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Tennessee rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $1,202.26 / $2,691.53
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$912.01 / $4,265.80 / $4,265.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $128.82 / $436.52
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$50.12 / $275.42 / $724.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $104.71 / $144.54
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$151.36 / $158.49 / $239.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,513.56 / $2,137.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $144.54 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $144.54 / $331.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $1,288.25 / $1,288.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $812.83 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $120.23 / $234.42