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New Hampshire 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
$100.00 / $5,013.10 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.50 / $1,386.53 / $2,767.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.10 / $5,299.00 / $8,600.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,092.66 / $1,718.76 / $2,964.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.15 / $1,984.44 / $2,909.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.96 / $2,247.02 / $4,450.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,155.00 / $11,155.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,514.89 / $1,782.37 / $3,357.96
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.96 / $1,234.59 / $1,582.73