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Wisconsin rates for HCPCS 67028

Intravitreal injection of a pharmacologic agent (separate procedure)

Facilitymedian $2,399 · 10th–90th $275$4,8980%10%10th90th$2,399Professionalmedian $170 · 10th–90th $87$6460%10%10th90th$170$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$169.82 / $467.74 / $776.25
Aetna
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$776.25 / $776.25 / $776.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $125.89 / $489.78
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$154.88 / $275.42 / $741.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $177.83 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$147.91 / $263.03 / $758.58
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $354.81 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $251.19 / $562.34
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $204.17 / $3,548.13
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $245.47 / $323.59
DeanCare
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$295.12 / $371.54 / $489.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $275.42 / $1,778.28
Medica
Facility/Professional
Facility
Modifier
50
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $346.74 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$295.12 / $501.19 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $151.36
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $323.59 / $436.52
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $239.88 / $398.11
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $1,288.25 / $1,288.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $512.86 / $3,235.94
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $537.03
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $891.25 / $1,096.48
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,584.89 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $309.03 / $691.83
United
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13