go back

Montana 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
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,874.48 / $1,874.48 / $1,874.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,874.48 / $1,874.48 / $1,917.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,090.00 / $2,090.00 / $2,090.00