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Virginia rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.49 / $1,918.83 / $5,743.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$759.91 / $1,638.72 / $2,036.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.83 / $114.35 / $222.29
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$164.09 / $269.67 / $918.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,735.00 / $2,390.00 / $2,954.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.28 / $106.50 / $172.63
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$124.92 / $159.75 / $258.61
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.97 / $225.03 / $1,013.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.82 / $153.82 / $153.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.34 / $134.05 / $264.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.03 / $123.56 / $158.66
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.65 / $140.65 / $342.37
Medcost
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$195.05 / $374.27 / $466.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.00 / $155.00 / $293.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.26 / $150.15 / $1,380.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.52 / $175.70 / $1,380.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $1,045.00 / $2,364.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.95 / $146.44 / $267.57