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Texas 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
$1,200.65 / $3,792.00 / $13,004.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,380.77 / $5,956.59 / $11,722.27
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,600.00 / $3,874.51 / $8,000.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.20 / $985.20 / $1,028.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,578.19 / $2,578.19 / $2,662.46
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $11,879.05
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,153.91 / $1,535.04 / $2,427.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,149.50 / $1,579.12 / $2,662.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $5,958.00 / $13,134.00