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Michigan rates for HCPCS 67043

Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (eg, choroidal neovascularization), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil) and laser photocoagulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,553.23 / $4,933.00 / $6,853.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,562.67 / $5,317.95 / $7,204.97
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,646.63 / $4,933.00 / $6,853.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,030.00 / $12,726.00