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Arizona 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
$1,170.00 / $2,640.00 / $5,506.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $253.90 / $466.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.35 / $2,283.06 / $3,616.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.97 / $201.74 / $255.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.50 / $263.95 / $515.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.95 / $344.20 / $2,594.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.15 / $294.98 / $2,025.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$968.00 / $1,958.00 / $3,268.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.10 / $278.60 / $526.79