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Alaska rates for HCPCS 67221

Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$777.38 / $6,541.00 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.55 / $279.30 / $1,493.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.01 / $715.01 / $910.70
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.23 / $340.86 / $2,135.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.95 / $721.35 / $1,466.50
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.25 / $1,047.50 / $1,370.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.72 / $415.45 / $2,135.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.38 / $1,010.00 / $1,511.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.00 / $728.56 / $2,206.19