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Pennsylvania rates for HCPCS 67041

Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,220.58 / $5,823.00 / $10,527.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.81 / $1,220.58 / $1,835.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,114.46 / $1,156.52 / $2,076.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,444.00 / $1,444.00 / $1,444.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.67 / $1,235.60 / $2,085.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.56 / $1,332.56 / $1,718.36
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,819.79 / $9,163.94 / $12,913.30
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.53 / $1,368.29 / $1,385.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $5,958.00 / $10,346.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.82 / $1,284.56 / $3,096.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.00 / $1,072.00 / $1,363.64
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,444.00 / $1,444.00 / $1,444.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.20 / $1,248.25 / $2,118.33
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.03 / $1,096.03 / $1,650.10
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.48 / $1,096.03 / $1,650.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,843.00 / $3,914.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.17 / $1,309.29 / $2,191.02