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Pennsylvania rates for HCPCS 67121

Removal of implanted material, posterior segment; intraocular

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$966.46 / $2,923.61 / $8,104.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,058.35 / $6,182.00 / $17,094.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,080.33 / $7,056.24 / $35,708.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,389.00 / $8,247.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$837.51 / $865.13 / $865.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,440.00 / $3,475.00 / $6,368.00