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West 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 / $792.42 / $2,381.96
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$669.28 / $2,088.67 / $2,716.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.74 / $112.74 / $193.73
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$129.15 / $283.35 / $287.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.65 / $101.58 / $126.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.22 / $116.11 / $237.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.82 / $153.82 / $153.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.39 / $159.37 / $427.20
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.08 / $710.70 / $1,333.30
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$576.15 / $1,421.39 / $2,174.59
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.20 / $155.74 / $213.81
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$233.61 / $278.00 / $337.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.95 / $163.55 / $430.11