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Texas 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)

Facilitymedian $4,169 · 10th–90th $1,175$12,3030%5%10%10th90th$4,169Professionalmedian $1,413 · 10th–90th $1,000$2,7540%10%10th90th$1,413$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $3,890.45 / $12,589.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,445.44 / $2,818.38
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,071.52 / $1,122.02
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,388.44 / $6,165.95 / $11,748.98
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,023.29 / $1,737.80
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,479.11 / $2,238.72
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $3,388.44 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,513.56 / $2,454.71
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $12,302.69
Lucent Health
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11,748.98 / $11,748.98 / $11,748.98
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,995.26 / $7,079.46
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,445.44 / $2,630.27
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $75.86 / $2,454.71
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,288.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,318.26 / $2,454.71
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,513.56 / $2,454.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $6,025.60 / $11,481.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,318.26 / $1,949.84
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $977.24 / $977.24