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Eye Surgery To Remove Fine Membrane From The Retina

Pennsylvania rates for HCPCS 67042

This is a surgical procedure that removes the clear gel filling the eye and then carefully peels away a very thin layer of tissue from the surface of the retina, the light-sensing layer at the back of the eye. It is used to treat conditions such as a macular hole or swelling of the macula caused by diabetes that distorts central vision.

Rates data updated July 2026.

How much does Eye Surgery To Remove Fine Membrane From The Retina cost?

$7,775

Typical total for the visit. In Pennsylvania, July 2026.

Insurers have agreed to pay about $7,775 for this procedure. That total is two separate charges: $1,318 to the doctor who performs it, and $6,457 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 12 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$1,318$1,175 to $1,585
Facility feeThe hospital or surgery center$6,457$4,266 to $8,128

How much rates vary

Facilitymedian $6,457 · 10th to 90th $1,585 to $10,715Professionalmedian $1,318 · 10th to 90th $1,096 to $3,020
$1K$2K$5K$10K$20Kfacility $6,457professional $1,318

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$6,165.95
Typical High
$9,772.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,348.96
Typical High
$3,019.95
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$4,786.30
Median
$7,244.36
Typical High
$17,378.01
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$9,549.93
Median
$10,000.00
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,148.15
Typical High
$2,089.30
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,380.38
Typical High
$2,187.76
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,584.89
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,380.38
Typical High
$2,344.23
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,897.79
Median
$8,317.64
Typical High
$17,378.01
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,380.38
Typical High
$1,380.38
Independence Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$4,677.35
Median
$7,244.36
Typical High
$14,125.38
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$5,623.41
Typical High
$10,471.29
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,380.38
Typical High
$3,630.78
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$2,089.30
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,778.28
Median
$5,248.07
Typical High
$8,912.51
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,096.48
Typical High
$1,778.28
United
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$5,011.87
Typical High
$12,302.69
United
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,318.26
Typical High
$2,344.23

Where Pennsylvania sits

The same service costs 5.7 times more in Maine than in Montana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Physician feeFacility fee

Pennsylvania· 22nd of 50

$7,775

$1,318 physician + $6,457 facility

ME $18,791MT $3,314

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.