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Pennsylvania 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
$1,286.72 / $5,254.00 / $10,398.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $28,970.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,444.00 / $1,444.00 / $1,444.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,301.00 / $5,742.00 / $11,083.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,444.00 / $1,444.00 / $1,444.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,155.32 / $1,155.32 / $1,917.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,843.00 / $3,879.00 / $7,508.00