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California rates for HCPCS 67042

Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,706.00 / $10,209.00 / $24,401.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.34 / $1,304.46 / $4,213.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.54 / $1,030.69 / $1,288.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,456.00 / $8,592.00 / $17,774.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,538.40 / $2,016.36 / $3,876.79
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $8,938.65
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.39 / $1,310.42 / $3,030.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.31 / $2,977.65 / $4,058.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,098.64 / $1,585.34 / $3,252.61
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.17 / $1,411.76 / $1,803.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.77 / $1,404.01 / $2,696.42
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,150.00 / $2,150.00 / $11,879.05
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$261.70 / $1,125.97 / $1,125.97
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,185.05 / $11,185.05 / $11,185.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,189.83 / $1,554.15 / $2,475.01
Providence
Facility/Professional
Facility
Modifier
80
Low / Median / High Price
$424.37 / $424.37 / $424.37
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$360.71 / $360.71 / $360.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,144.30 / $1,664.61 / $3,197.11
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,760.89 / $3,760.89 / $3,760.89
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.46 / $1,411.76 / $2,017.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,478.00 / $12,150.00 / $26,109.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.84 / $1,271.76 / $2,769.48