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Arkansas rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.75 / $975.00 / $2,812.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.21 / $246.09 / $387.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.12 / $398.12 / $398.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$539.80 / $539.80 / $647.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.22 / $292.80 / $381.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$590.29 / $590.29 / $590.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.56 / $366.64 / $495.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.00 / $765.00 / $1,574.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.75 / $320.16 / $522.78